Description

Schembri et al developed a score for identifying Scottish patients with COPD who are at increased risk for all cause mortality. This can help identify patients who may benefit from more aggressive management. The authors are from Ninewells Hospital in Dundee

Patient selection: COPD was defined as an FEV1 < 80% of predicted

Parameters:

(1) age of the patient in years

(2) gender

(3) body mass index (BMI)

(4) current smoker

(5) pack years of smoking

(6) MRC dyspnoea score

(7) shuttle test in meters

(8) FEV1 as percent of predicted

(9) FVC in liters

(10) use of oxygen at home

(11) housebound

(12) previous respiratory or cardiovascular hospital admission

Parameter

Finding

Points

age of the patient in years

< 50 years

0

50 to 59 years

1

60 to 69 years

2

70 to 79 years

4

>= 80 years

5

gender

female

0

male

2

body mass index

< 18.5

1

18.5 to 25.0

-1

> 25.0

-2

current smoker

no

0

yes

1

pack years of smoking

unknown

0

0 (nonsmoker)

-5

< 30

-1

>= 30

0

MRC dyspnoea score

1 or 2

0

3

1

4 or 5

2

shuttle test

not performed

0

< 25 meters

0

25 to 200 meters

-3

> 200 meters

-4

FEV1 as percent of predicted

51 - 80%

0

30 to 50%

1

< 30%

1

FVC in liters

0 to 1 liters

5

1 to 3 liters

1

3 to 4 liters

0

> 4 liters

-1

home oxygen

no

0

yes

3

housebound

no

0

yes

2

no

0

yes

1

where:

• The points for FEV1 < 30% of predicted seem suspect.

total score =

= SUM(points for all 12 parameters)

Interpretation:

• minimum score: -12

• maximum score: 23

• The mortality is low for patients with scores < 0.

• Mortality rises as the score increases above 0.

• The higher the score the greater the risk of all cause mortality.

Risk of mortality in Y years (with Y from 1 to 5 years):

Z =

= (LN(Y) - (2.8 - (0.196 * (score)))) / 0.657

risk of all cause mortality in Y years =

= 1 - EXP((-1) * EXP(Z))

NOTE: The parentheses in the formula given in the text do not match (6 forward but only 5 back). The formula given here is based on the formula in the diagram.