Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, The Netherlands.
Respiration. 2021;100(8):780-785. doi: 10.1159/000516291. Epub 2021 May 27.
Idiopathic pulmonary fibrosis (IPF) is a progressive fatal disease with a heterogeneous disease course. Timely initiation of palliative care is often lacking. The surprise question "Would you be surprised if this patient died within the next year?" is increasingly used as a clinical prognostic tool in chronic diseases but has never been evaluated in IPF.
We aimed to evaluate the predictive value of the surprise question for 1-year mortality in IPF.
In this prospective cohort study, clinicians answered the surprise question for each included patient. Clinical parameters and mortality data were collected. The sensitivity, specificity, accuracy, negative, and positive predictive value of the surprise question with regard to 1-year mortality were calculated. Multivariable logistic regression analysis was performed to evaluate which factors were associated with mortality. In addition, discriminative performance of the surprise question was assessed using the C-statistic.
In total, 140 patients were included. One-year all-cause mortality was 20% (n = 28). Clinicians identified patients with a survival of <1 year with a sensitivity of 68%, a specificity of 82%, an accuracy of 79%, a positive predictive value of 49%, and a negative predictive value of 91%. The surprise question significantly predicted 1-year mortality in a multivariable model (OR 3.69; 95% CI 1.24-11.02; p = 0.019). The C-statistic of the surprise question to predict mortality was 0.75 (95% CI 0.66-0.85).
The answer on the surprise question can accurately predict 1-year mortality in IPF. Hence, this simple tool may enable timely focus on palliative care for patients with IPF.
特发性肺纤维化（IPF）是一种进行性致命疾病，其病程具有异质性。姑息治疗往往不能及时开始。“如果这个患者在未来一年内去世，你会感到惊讶吗？”这个意外问题越来越多地被用作慢性疾病的临床预后工具，但从未在 IPF 中进行过评估。
我们旨在评估意外问题对 IPF 患者 1 年死亡率的预测价值。
在这项前瞻性队列研究中，临床医生为每位纳入的患者回答意外问题。收集临床参数和死亡率数据。计算意外问题对 1 年死亡率的敏感性、特异性、准确性、阴性预测值和阳性预测值。进行多变量逻辑回归分析，以评估哪些因素与死亡率相关。此外，还使用 C 统计量评估意外问题的判别性能。
共纳入 140 名患者。1 年全因死亡率为 20%（n=28）。临床医生确定了生存期<1 年的患者，其敏感性为 68%，特异性为 82%，准确性为 79%，阳性预测值为 49%，阴性预测值为 91%。意外问题在多变量模型中显著预测 1 年死亡率（OR 3.69；95%CI 1.24-11.02；p=0.019）。意外问题预测死亡率的 C 统计量为 0.75（95%CI 0.66-0.85）。
意外问题的答案可以准确预测 IPF 的 1 年死亡率。因此，这种简单的工具可以使 IPF 患者及时关注姑息治疗。
