COPD Risk Score May Help Guide Care Decisions

A laboratory result-based score for estimating outcomes of patients with chronic obstructive pulmonary disease (COPD) was associated with all-cause mortality and referrals to palliative care.

The Laboratory-based Intermountain Validated Exacerbation (LIVE) score is a model that takes blood test results for levels of hemoglobin, albumin, creatinine, chloride, and potassium to calculate which patients with COPD are at high risk of death or disease progression. Patients at highest risk have LIVE scores of 1 while those at lowest risk have LIVE scores of 5.

The results were presented at the 2019 American Thoracic Society (ATS) International Conference in Dallas, TX, by the study’s lead author, Denitza Blagev, MD, a pulmonary and critical care physician at Intermountain Medical Center, who serves as medical director for Quality, Specialty Based Care at Intermountain Healthcare in Salt Lake City.

"We found the LIVE score helps personalize therapy to patients beyond the COPD diagnosis alone and provides additional risk information to both patients and their doctors," said Blagev. She added that the LIVE score allows for more personalized care based on an individual patient’s risk rather than the single diagnosis of COPD.

The retrospective study included 17,124 participants diagnosed with COPD who were in the Kaiser Health System in 2013 and had the necessary lab results to calculate a LIVE score. All-cause mortality and palliative care referral rates at 4 years were assessed compared to 2013 LIVE scores.

Patients at high risk (LIVE 1) had the highest mortality rate—63.3% at 4 years&mdash;compared to patients at the lowest risk in 2013 (LIVE 5) who had a mortality rate of 4.3% at 4 years (P <.001). Additionally, 75.8% of patients with LIVE 1 scores were referred to palliative care within 4 years, while 18.8% of those with LIVE 5 scores received the referral (P <.001).

One-year data for these outcomes was similar to the 4-year data. Patients with LIVE 1 scores had mortality rates of 39.4% compared to 0.7% for those with LIVE 5 scores. Referral rates for palliative care were 41.7% and 0.7%, respectively.

Blagev noted that learning about the association between LIVE score risk and palliative care referrals is a step forward in using LIVE scores to provide the best possible patient care.

"Our findings lend more insight into how we can use these laboratory-based scores at the bedside to ensure that patients are receiving the most appropriate care," Blagev said. "This doesn't mean everyone with high risk needs to be referred to palliative care, but it shows potential opportunities to improve care for patients in that highest risk group.”

The abstract, “Laboratory-Based Intermountain Validated Exacerbation (LIVE) Score and Palliative Care Referrals in Patients with Chronic Obstructive Pulmonary Disease,” was presented on May 21 at the ATS 2019 International Conference.