Prognostic variables and scores identifying the end of life in COPD: a systematic review
Received 24 March 2017
Accepted for publication 30 May 2017
Published 31 July 2017 Volume 2017:12 Pages 2239—2256
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Charles Downs
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Laura-Jane E Smith,1 Elizabeth Moore,1 Ifrah Ali,1 Liam Smeeth,2 Patrick Stone,3 Jennifer K Quint1,2
1Department of Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, 2Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, 3Marie Curie Palliative Care Research Unit, University College London, UK
Introduction: COPD is a major cause of mortality, and the unpredictable trajectory of the disease can bring challenges to end-of-life care. We aimed to investigate known prognostic variables and scores that predict prognosis in COPD in a systematic literature review, specifically including variables that contribute to risk assessment of patients for death within 12 months.
Methods: We conducted a systematic review on prognostic variables, multivariate score or models for COPD. Ovid MEDLINE, EMBASE, the Cochrane database, Cochrane CENTRAL, DARE and CINAHL were searched up to May 1, 2016.
Results: A total of 5,276 abstracts were screened, leading to 516 full-text reviews, and 10 met the inclusion criteria. No multivariable indices were developed with the specific aim of predicting all-cause mortality in stable COPD within 12 months. Only nine indices were identified from four studies, which had been validated for this time period. Tools developed using expert knowledge were also identified, including the Gold Standards Framework Prognostic Indicator Guidance, the RADboud Indicators of Palliative Care Needs, the Supportive and Palliative Care Indicators Tool and the Necesidades Paliativas program tool.
Conclusion: A number of variables contributing to the prediction of all-cause mortality in COPD were identified. However, there are very few studies that are designed to assess, or report, the prediction of mortality at or less than 12 months. The quality of evidence remains low, such that no single variable or multivariable score can currently be recommended.
Keywords: COPD, palliative care, end of life
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