Source: Annual Congress 2011 - Exacerbations and severe chronic respiratory disease: oxygen, rehabilitation, admission to hospital and palliative care
Disease area: Airway diseases

Abstract

Background
In the UK prognostic indicators have been developed for predicting end of life (EOL) in COPD.
We report on the prevalence of these indicators in patients admitted to a nurse led unit for people with acute exacerbations of COPD (AECOPD).
Methods
Data on general and COPD specific prognostic indicators plus the surprise question were collected on all admissions Aug 2010 to Jan 2011.
Results
Total 199 patients (54%F). Mean age 70 (37-93)
In 96 (48%) cases the clinician would not have been surprised if the patient died in the next 6-12 months. In only 5 of these instances were no other prognostic indicators identified (positive predictive value of negative response 95%)
174 (87%) had at least 1 prognostic indicator identified at the time of admission.

prognostic indicators and surprise question

Prognostic Indicator	Surprise Q "No" (n=96) No(%)	Surprise Q "Yes" (n=103) No(%)
Co-morbidities (IHD/HF/DM)	45 (47)	43 (42)
Wt Loss >10% over 6 months)	9 (9)	2 (2)
BMI <19	17 (18)	7 (7)
Albumin <25g/dl	0	0
Karnofsky <50	9 (9)	1 (1)
> 3 admissions in 12 mths	35 (37)	8 (8)
LTOT	24 (25)	6 (6)
MRC 5	44 (46)	16 (16)
FEV1 <30% pred	33 (34)	31 (31)
Right Heart Failure	13 (14)	4 (4)
NIV/ ICU	28 (29)	9 (9)
Sputum MRSA or Pseudomonas	12 (13)	7 (7)
> 6 courses of steroid in 12 mths	19 (20)	13 (13)
HAD Depression >11	26 (27)	23 (23)

Of the 15 deaths so far there was a negative response to the surprise question in 14 and in all at least 1 other prognostic indicator was present.
Conclusions
Prognostic indicators were present in 87% of patients admitted.
The surprise question should form part of admission assessment.
It is too early to say which prognostic indicators are important in predicting EOL.

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Citations should be made in the following way:
G. South, O. Reddington, L. Hatfield, A. Phillips, H. Wall (Rotherham, Leicester, United Kingdom). End of life in COPD: There may be no surprises!. Eur Respir J 2011; 38: Suppl. 55, 1241

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