Smith Laura-Jane E, Moore Elizabeth, Ali Ifrah, Smeeth Liam, Stone Patrick, Quint Jennifer K
Department of Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London.
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
Int J Chron Obstruct Pulmon Dis. 2017 Jul 31;12:2239-2256. doi: 10.2147/COPD.S137868. eCollection 2017.
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.
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.
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.
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.
慢性阻塞性肺疾病（COPD）是主要的死亡原因，该疾病不可预测的病程会给临终关怀带来挑战。我们旨在通过系统的文献综述，研究已知的预测COPD预后的变量和评分，特别包括有助于评估患者在12个月内死亡风险的变量。
我们对COPD的预后变量、多变量评分或模型进行了系统综述。截至2016年5月1日，检索了Ovid MEDLINE、EMBASE、Cochrane数据库、Cochrane CENTRAL、DARE和CINAHL。
共筛选了5276篇摘要，得到516篇全文综述，其中10篇符合纳入标准。没有专门为预测稳定期COPD患者12个月内全因死亡率而开发的多变量指标。从四项研究中仅确定了九个指标，这些指标在该时间段内已经过验证。还确定了使用专家知识开发的工具，包括金标准框架预后指标指南、拉德堡姑息治疗需求指标、支持性和姑息治疗指标工具以及姑息治疗需求计划工具。
确定了一些有助于预测COPD全因死亡率的变量。然而，很少有研究旨在评估或报告12个月及以内的死亡率预测情况。证据质量仍然较低，因此目前无法推荐单一变量或多变量评分。
