Materiały źródłowe

• #1 Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2662972/

  Purpose: Limited data exist describing risk factors for mortality in patients having predominantly emphysema. […] Overall, high mortality was seen in this cohort (12.7 deaths per 100 person-years; 292 total deaths). In multivariate analyses, increasing age (p = 0.001), oxygen utilization (p = 0.04), lower total lung capacity % predicted (p = 0.05), higher residual volume % predicted (p = 0.04), lower maximal cardiopulmonary exercise testing workload (p = 0.002), greater proportion of emphysema in the lower lung zone versus the upper lung zone (p = 0.005), and lower upper-to-lower-lung perfusion ratio (p = 0.007), and modified BODE (p = 0.02) were predictive of mortality. […] Although patients with advanced emphysema experience significant mortality, subgroups based on age, oxygen utilization, physiologic measures, exercise capacity, and emphysema distribution identify those at increased risk of death.

• #2 Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2662972/

  In this study of patients with severe emphysema randomized to the medical arm of the NETT, we document that increased mortality was independently associated with the following: (1) greater age, (2) use of oxygen supplementation, (3) lower hemoglobin, (4) higher RV (as % predicted), (5) lower DlCO % predicted, (7) lesser maximal exercise performance on cardiopulmonary exercise testing, (8) a higher modified BODE, and (9) greater lower-lung zone emphysema. […] Our results demonstrate the strengths and limitations of physiologic testing in predicting survival in patients with COPD. […] Our data suggest that the overall percentage of emphysema does not independently influence survival in a large cohort of patients with severe emphysema.

• #3 Development and validation of a multivariable mortality risk prediction model for COPD in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9156666/

  Risk stratification of chronic obstructive pulmonary disease (COPD) patients is important to enable targeted management. […] We sought to develop and validate a prognostic model to predict 10-year mortality in patients with diagnosed COPD. […] According to the validated prognostic model, the two most important risk factors of mortality were heart failure (HR 1.92; 95% CI 1.87-1.96) and current smoking (HR 1.68; 95% CI 1.66-1.71). […] The most significant risk factors associated with mortality (with at least a 50% increased risk) after COPD diagnosis were having heart failure and being a current smoker (compared to non-smoker). […] The prognostic model found several risk factors to be associated with 10-year mortality, with varying degrees of strength. The most significant of these factors were heart failure and being a current smoker; in contrast, history of ARIs and asthma were not independent risk factors of poor prognosis.

• #4 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/297664-overview

  Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. […] The FEV1 was used to predict outcome in COPD until other factors were identified to play a role in determining the outcome of COPD patients. These discoveries resulted in the creation of the multidimensional BODE index (body mass index, obstruction [FEV1], dyspnea [modified Medical Research Council dyspnea scale], and exercise capacity). […] Prognosis is based on a point system, with all 4 factors used to determine the score, as follows: Body mass index: greater than 21 = 0 points; less than 21 = 1 point; FEV1 (postbronchodilator percent predicted): greater than 65% = 0 points; 50-64% = 1 point; 36-49% = 2 points; less than 35% = 3 points; Modified Medical Research Council (MMRC) dyspnea scale: MMRC 0 = dyspneic on strenuous exercise (0 points); MMRC 1 = dyspneic on walking a slight hill (0 points); MMRC 2 = dyspneic on walking level ground, must stop occasionally due to breathlessness (1 point); MMRC 3 = dyspneic after walking 100 yards or a few minutes (2 points); MMRC 4 = cannot leave house; dyspneic doing activities of daily living (3 points); Six-minute walking distance: greater than 350 meters = 0 points; 250-349 meters = 1 point; 150-249 meters = 2 points; less than 149 meters = 3 points.

• #5 Chronic Obstructive Pulmonary Disease (COPD): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/297664-overview

  The approximate 4-year survival based on the point system above is as follows: 0-2 points = 80%; 3-4 points = 67%; 5-6 points = 57%; 7-10 points = 18%. […] The use of a clinical scoring system reinforces that determinants of prognosis in COPD remain multifactorial. […] A study by Sundh et al determined that the Clinical COPD Questionnaire (CCQ), which estimates quality of life in patients with COPD, is effective. […] In a multicenter, prospective, observational study of 201 consecutive patients with moderate-to-severe COPD, Martinez-Garcia et al reported that in addition to smoking, pulmonary hypertension, and declining lung function (known risk factors for mortality in patients with COPD), bronchiectasis (which is common in patients with moderate-to-severe COPD) is independently associated with increased risk of all-cause mortality. […] In this study, those who had bronchiectasis were found to be 2.5 times more likely to die than those who did not.

• #6 Prediction of Mortality Using Different COPD Risk Assessments – | COPD

  https://www.dovepress.com/prediction-of-mortality-using-different-copd-risk-assessments-ndash-a–peer-reviewed-fulltext-article-COPD

  The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices. […] By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3 4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75 0.83) for all-cause mortality and 0.80 (95% CI 0.75 0.85) for respiratory mortality. […] All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.

• #7 Prediction of Mortality Using Different COPD Risk Assessments – | COPD

  https://www.dovepress.com/prediction-of-mortality-using-different-copd-risk-assessments-ndash-a–peer-reviewed-fulltext-article-COPD

  The primary finding was that overall, all risk assessment systems predicted all-cause mortality and respiratory mortality. The secondary finding is that the ADO index had the most accurate predictive ability. […] The ADO index had the highest AUC for respiratory mortality. […] In this 12-year follow-up, out of all risk assessment systems to predict mortality, the ADO index was the most accurate, followed by an assessment by lung function.

• #8 Developing and validating prediction models for severe exacerbations and readmissions in patients hospitalised for COPD exacerbation (SERCO) in China: a prospective observational study | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/11/1/e001881

  The SERCO model provides individual predictions for severe exacerbation and COPD-specific readmission risk, which enables identifying high-risk patients and implementing personalised preventive intervention for patients with COPD. […] Among patients hospitalised for AECOPD, the severe exacerbations and readmissions in patients hospitalised for COPD exacerbation (SERCO) model shows good performance for predicting the risk of severe exacerbations and COPD-specific readmissions at 1, 6 and 12 months after discharge. […] The SERCO model discriminated outcomes better than prior severe exacerbation history. […] The model-driven risk groups showed significant disparities in prognosis. […] The SERCO model was consistently discriminative and accurate with C-indexes in the derivation and internal validation groups.

• #9 Developing and validating prediction models for severe exacerbations and readmissions in patients hospitalised for COPD exacerbation (SERCO) in China: a prospective observational study | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/11/1/e001881

  The C-indexes of SERCO for severe exacerbations at 1 month, 6 months and 12 months were 77.3, 76.5 and 74.7, respectively. […] Compared with the history of severe exacerbations in the past 12 months, SERCO has better discrimination ability. […] The decision curve analysis indicates that the SERCO models have net benefits within the predictive probability threshold range of 1.5% to 5% for 1-month outcomes, 5% to 25% for 6-month outcomes and 7% to 35% for 12-month outcomes. […] SERCO enables clinicians to predict individual short-term, medium-term and long-term risks of severe exacerbations and COPD-specific readmissions in patients hospitalised for AECOPD.

• #10 Prediction of five-year mortality after COPD diagnosis using primary care records | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236011

  Accurate prognosis information after a diagnosis of chronic obstructive pulmonary disease (COPD) would facilitate earlier and better informed decisions about the use of prevention strategies and advanced care plans. […] We have developed and validated a model that outperforms general multimorbidity scores at predicting five-year mortality after COPD diagnosis. […] Our model performed well, and performed consistently in validation data. The validation area under the curves in each country varied between 0.7830.809 and the calibration slopes between 0.9111.04. […] We have used a large primary care cohort to develop and validate the iCOPD model for the prediction of mortality within 5 years of a COPD diagnosis, using only variables already recorded within health records at the time of diagnosis. […] iCOPD achieved area under the curves of between 0.7830.809 and calibration slopes between 0.9111.04 in validation cohorts from across the UK not used in model development. […] Importantly, iCOPD had relatively consistent performance between development and validation cohorts.

• #11 Prediction of long-term clinical outcomes using simple functional exercise performance tests in patients with COPD: a 5-year prospective cohort study | Respiratory Research | Full Text

  https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-017-0598-6

  The 1-min STS test was strongly associated with long-term mortality (hazard ratio per 3 more repetitions: 0.81, 95% CI 0.65 to 0.86) and moderately associated with long-term HRQoL. […] Our results suggest that the 1-min STS test may be useful for assessing the health status and long-term prognosis of COPD patients. […] We found that over 5 years, the 1-min STS test was strongly associated with mortality and moderately associated with HRQoL. […] The present study suggests that the 1-min STS test has long-term predictive validity for mortality and that associations with outcomes only diminish slightly over 5 years. […] In conclusion, the 1-min STS test as a measure of functional exercise performance showed good long-term predictive validity for the mortality and moderate predictive validity for HRQoL.

• #12 FF #141 Prognosis in End-Stage COPD – Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognosis-in-end-stage-copd/?print=print

  Prognostic variables in COPD patients are not well described, thus decision making regarding when to move away from aggressive life-sustaining treatments is challenging. […] A FEV1 of less than 35% of the predicted value represents severe disease; 25% of these patients will die within two years and 55% by four years. […] A number of other studies have shown that age, low body mass index (BMI), serum inflammatory biomarkers (such as C-reactive protein, IL-6, and fibrinogen) and low PaO2 were independent predictors that correlated to reduced survival time. […] The BODE scale, consisting of BMI, exercise capacity, and subjective estimates of dyspnea, has been shown to help predict survival over 1-3 years. […] Mortality statistics vary for patients admitted with COPD exacerbations depending on age, functional status, co-morbidities, and physiological variables such as hypoxia and hypercarbia.

• #13 FF #141 Prognosis in End-Stage COPD – Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/prognosis-in-end-stage-copd/?print=print

  Roughly 10% of patients admitted with a PaCO2 >50 mmHg will die during the index hospitalization, 33% will die within six months, and 43% die within one-year. […] Poor prognostic factors include: co-morbid illnesses, severity of illness (APACHE II score), low serum albumin, and/or low hemoglobin. […] In one study, patients ventilated more than 48 hours had a 50% one year survival; functional status and severity of illness were associated with short term mortality while age and co-morbidities were associated with one year mortality. […] However, a study showed when using these factors, 50% of the patients were still alive at six months, implying that the NHPCO criteria have a limited role in predicting six month mortality and thus should be used with caution in determining hospice eligibility under the Medicare Hospice Benefit. […] For ambulatory patients, age, degree of dyspnea, weight loss (BMI), functional status, and FEV1 are relevant prognostic factors for predicting 1-3 year survival. […] In addition, the need for prolonged or recurrent mechanical ventilation is predictive of a shorter prognosis.

• #14 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal | The BMJ

  https://www.bmj.com/content/367/bmj.l5358

  Objective To map and assess prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease (COPD). […] The systematic search yielded 228 eligible articles, describing the development of 408 prognostic models, the external validation of 38 models, and the validation of 20 prognostic models derived for diseases other than COPD. […] Overall, the most commonly used predictors were age (n=166; 41%), forced expiratory volume in one second (n=85; 21%), sex (n=74; 18%), body mass index (n=66; 16%), and smoking (n=65; 16%). […] Only seven prognostic models with an overall low risk of bias according to PROBAST were identified. […] This study constitutes a detailed mapping and assessment of the prognostic models for outcome prediction in COPD patients. […] Future research should focus on the improvement of existing models through update and external validation, as well as the assessment of the safety, clinical effectiveness, and cost effectiveness of the application of these prognostic models in clinical practice through impact studies.

• #15 Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal | The BMJ

  https://www.bmj.com/content/367/bmj.l5358

  Our systematic review showed several methodological pitfalls in the development of the models, which is also reflected in the risk of bias assessment. […] An important finding of our systematic review was that only a quarter of the models assessed calibration, which is the accuracy of absolute risk estimates that informs clinicians how similar the predicted absolute risk is to the true (observed) risk in groups of patients classified in different risk strata. […] The vast majority of prognostic models predicted the risk for mortality. Other clinically important outcomes, such as risk for exacerbation, a very common outcome in randomised clinical trials for COPD treatment, attracted much less attention. […] An essential step before the application of prediction models in clinical practice is their external validation in independent populations with different clinical characteristics and comparison of performance among different prediction models to identify the models with the best discrimination and calibration. […] Future prognostic research should steer towards recalibration or update of existing prognostic models with the addition of new predictors to enhance their prognostic performance.

• #16 Predicting future health risk in COPD | COPD

  https://www.dovepress.com/predicting-future-health-risk-in-copd-differential-impact-of-disease-s-peer-reviewed-fulltext-article-COPD

  Multi-morbidity contributes to mortality and hospitalisation in COPD, but it is uncertain how this interacts with disease severity in risk prediction. […] Mortality was best predicted by disease severity (AUC 95% CI: 0.816 (0.805 0.827)) and prediction was enhanced only marginally by the addition of multi-morbidity indices (AUC 95% CI: 0.829 (0.818 0.839)). […] A more comprehensive risk modelling algorithm such as ACG offers enhanced prediction for hospitalisation by incorporating a wider range of coded diagnoses. […] This study demonstrates that the performance of risk stratification models for patients with COPD managed in primary care differs depending on the outcome in question (hospitalisation or mortality) and whether disease-specific characteristics or patterns of multi-morbidity are included as predictor variables.

• #17 Predicting future health risk in COPD | COPD

  https://www.dovepress.com/predicting-future-health-risk-in-copd-differential-impact-of-disease-s-peer-reviewed-fulltext-article-COPD

  Our observation of overall better prediction performance for mortality likely reflects the primacy of biological/pathophysiological factors predicting death. […] Our findings suggest that for mortality prediction, the severity of the reference condition (COPD) is a key indicator, as the addition of clinically important and prevalent multi-morbidity did not further enhance predictive power. […] For hospitalisation, multi-morbidity regression models performed comparably to demographic and COPD-specific models. […] The use of complex multi-morbidity based risk profiling methodologies such as ACG in combination with disease severity indices may assist in the prediction of healthcare utilisation.

• #18 Prediction of COPD-specific health-related quality of life in primary care COPD patients: a prospective cohort study | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/npjpcrm201460

  To predict COPD-specific HRQL in primary care COPD patients, previous HRQL was the best predictor in our models. […] Asking patients explicitly about dyspnoea, fatigue, depression and how they cope with COPD provides additional important information about future HRQL whereas FEV1 or other commonly used predictors add little to the prediction of HRQL. […] We found that COPD-specific HRQL after 6 and 24 months in primary care COPD patients could be reasonably well predicted by the corresponding domain-specific score at baseline. […] These models could be improved by adding between one to six other predictors to the strongest predictor, such as the HADS, the feeling thermometer and the other domain-specific CRQ scores. […] A prediction model as such only does what the name suggests: predict. By itself, it does not change the course of disease.

• #19 Prediction of COPD-specific health-related quality of life in primary care COPD patients: a prospective cohort study | npj Primary Care Respiratory Medicine

  https://www.nature.com/articles/npjpcrm201460

  Future studies should further validate our models in other populations with respect to discrimination and calibration. […] Our current study shows that COPD-specific HRQL is no exception to the rule that a previous measurement of a phenomenon usually is a strong predictor of the (probability of) the next occurrence.

• #20 Patient education: Chronic obstructive pulmonary disease (COPD) treatments (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-obstructive-pulmonary-disease-copd-treatments-beyond-the-basics

  COPD PROGNOSIS […] Although COPD usually worsens over time, it is difficult to predict how quickly it will progress and how long you will live (your prognosis). A number of factors play a role in the severity of COPD symptoms, including whether you continue to smoke, are underweight, or have other medical problems, and how your lungs function during exercise. People with COPD who have less severe symptoms, are a healthy weight, and do not smoke tend to live longer. […] The „BODE index” is an example of a tool that clinicians use to predict survival and to make decisions about timing when lung transplantation is being considered. It involves a calculation using data including body mass index (BMI), severity of airflow obstruction on spirometry, degree of shortness of breath with exertion, and distance walked in six minutes. The calculation results in a number that your provider can use to help predict your prognosis.

• #21 A simple clinical prognosis tool to predict mortality after a first hospitalization for COPD

  https://www.hilarispublisher.com/proceedings/a-simple-clinical-prognosis-tool-to-predict-mortality-after-a-first-hospitalization-for-copd-33081.html

  Chronic obstructive pulmonary disease (COPD) is a very prevalent disease associated with high mortality, morbidity, healthcare utilization and cost. […] A total 12.5% of patients died within one year from discharge. […] It was concluded that one over eight patients discharged alive from a first COPD hospitalization die the following year. It is thus important to identify high risk patients in order to plan and manage appropriate treatment.

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