S.NG1, G.T.CHAI2, P.KAUR1, W.F.YIP1, P.GEORGE1, Z.Y.CHIAM2, H.Y.NEO2, W.S.TAN1, A.HUM3
National Healthcare Group HQ1, Tan Tock Seng Hospital2, The Palliative Care Centre for Excellence in Research and Education3
Patients with end-stage organ failure experience significant symptom burden and prognostication is pertinent in timely identification of these patients for referral to palliative care1. Prognostic factors of end-stage lung disease (ESLD) have been studied primarily in patients with chronic obstructive pulmonary disease (COPD)2–6. As ESLD would constitute a heterogenous group of conditions beyond COPD, we aimed to identify from literature other ESLD conditions, and summarise the prognostic factors associated with them.
We conducted a scoping review following frameworks by Arksey and O’Malley and Riley et al7,8. We searched MEDLINE, Embase, PubMed, CINAHL, Cochrane Library and Web of Science for studies published between 2000 and 2020 that described ESLD populations with an all-cause mortality risk period of up to 3 years. These included populations with interstitial lung disease (ILD), connective tissue disease-associated ILD (CTD-ILD), bronchiectasis and pulmonary hypertension associated with chronic lung disease. Only primary studies which reported associations adjusted through multivariable analysis were included.
55 studies were reviewed, with 53 based on ILD or CTD-ILD populations and 2 on bronchiectasis populations. Half of the studies looked at mortality up to 1 year. Older age, lower forced vital capacity and lower carbon monoxide diffusing capacity were most commonly investigated and frequently associated with statistically significant increases in mortality risk.
Literature on the prognostication of 3-year mortality in non-COPD ESLD conditions focused on ILD populations, and only a subset looked at 1-year mortality relevant for palliative referral. This study identified frequently investigated prognostic factors of mortality for use in model development.