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

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