Predicting end-of-life in patients with an exacerbation of COPD by routine clinical assessment

The purpose of this study was to determine if routine clinical assessment could reliably predict in-hospital death in patients admitted with acute exacerbation of COPD (AECOPD).

In a case-crossover study the case records of AECOPD related deaths were reviewed. Clinical and laboratory variables including performance status (WHO-PS) and a composite physiological score (early warning score, EWS) at initial clinical assessment on final admission (FA) and penultimate admission (PA) for AECOPD were compared.

Sixty patients included in study, female 60%, mean age (SD) 75 (8.7) years. 98% had ≥2 admissions for AECOPD. On univariate analysis variables associated with death were: Charlson score, WHO-PS, EWS, pH<7.35, Urea and CRP. On multivariate analysis predictors of mortality were: WHO-PS (OR 95% CI: 4.9 (1.06-22.61); p=0.04) and EWS (OR 95% CI: 3.39 (1.56-7.41); p=0.002). ROC analysis of relationship between combined WHO-PS/EWS score and death gave AUC 0.86; a total score≥6 had sensitivity 78% and specificity 86.2% and on multivariate analysis OR (95% CI) for death was 19.3 (4.3-86.2); p<0.0005.

In-hospital deaths from AECOPD may be predicted by assessment of WHO-PS and EWS on admission to hospital.