Chronic obstructive pulmonary disease (COPD) is a common, progressive lung condition most often caused by smoking. Patients with advanced disease often have a poor quality of life and are at high risk of early death. COPD is incurable, and palliative care (directed at managing symptoms) can improve quality of life. However, patients with COPD are less likely to receive palliative care than other patients, partly because it is more difficult to predict when patients with COPD are nearing the end of life. In this study we will examine anonymous data from thousands of patients and look for factors, or groups of factors, which predict which patients with COPD are more likely to die. We will test existing prognostic scores, and generate a new prognostic score, aiming to identify patients who are more likely to die within the next year with the greatest possible confidence. This could assist communication, shared decision-making, and advance care planning.
We will use CPRD GOLD data linked with HES and ONS to investigate the recording of currently identified prognostic markers for COPD. We will identify patients within CPRD with validated Read codes for COPD and investigate factors associated with mortality. We will test any existing prognostic risk models which use factors which are routinely recorded in electronic health records. We will generate a novel prognostic model using a range of putative prognostic variables. We will use multivariate logistic regression and more advanced statistical methods, aiming to create a model with greater confidence for prediction of death in the year following the annual COPD check-up. More accurate risk stratification could assist communication, shared decision-making, and advance care planning.
Jennifer Quint - Chief Investigator - Imperial College London
Laura-Jane Smith - Corresponding Applicant - Imperial College London
Cosetta Minelli - Collaborator - Imperial College London
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Patrick Stone - Collaborator - UCL Hospital
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation