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 |
previous respiratory or cardiovascular admission |
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.
Purpose: To evaluate a patient with COPD for all cause mortality using the score of Schembri et al.
Specialty: Pulmonology
Objective: risk factors, severity, prognosis, stage, complications
ICD-10: J42, J43, J44,