COPD is a heterogeneous disease without a simple prognostic trajectory, challenging decision-making regarding when to move away from aggressive life-sustaining treatments.
Ambulatory COPD patients
. The forced expiratory volume in one second (FEV1) is used to assess COPD severity. 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 (C-reactive protein, IL-6, and fibrinogen) and low PaO2 were independent predictors that correlated to reduced survival time.
Hospitalized COPD patients
. 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 – those with less severe COPD have lower in-hospital mortality rates. COPD patients who require mechanical ventilation have an-hospital mortality of ~25%. Poor prognostic factors include: co-morbid illnesses, severity of illness, low serum albumin, and/or low hemoglobin. Previous mechanical ventilation, failed extubation, or intubation for greater than 72 hours all increase mortality.
NHPCO (National Hospice and Palliative Care Organization) guidelines for hospice admission in COPD include: cor pulmonale and pO2 <55 mmHg while on oxygen, albumin <2.5 gm/dl, weight loss of >10%, progression of disease, and poor functional status.
See reference for more information.
Adapted from Childers JW, Arnold R, Curtis JR. Prognosis in end-stage COPD. Pharmacologic management. Palliative Care Network of Wisconsin. Fast facts and concepts #141. Internet. Accessed on January 22, 2020.