BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive fatal disease with a heterogeneous disease course. Timely initiation of palliative care is often lacking. The surprise question "Would you be surprised if this patient died within the next year?" is increasingly used as a clinical prognostic tool in chronic diseases but has never been evaluated in IPF. OBJECTIVE: We aimed to evaluate the predictive value of the surprise question for 1-year mortality in IPF. METHODS: In this prospective cohort study, clinicians answered the surprise question for each included patient. Clinical parameters and mortality data were collected. The sensitivity, specificity, accuracy, negative, and positive predictive value of the surprise question with regard to 1-year mortality were calculated. Multivariable logistic regression analysis was performed to evaluate which factors were associated with mortality. In addition, discriminative performance of the surprise question was assessed using the C-statistic. RESULTS: In total, 140 patients were included. One-year all-cause mortality was 20% (n = 28). Clinicians identified patients with a survival of <1 year with a sensitivity of 68%, a specificity of 82%, an accuracy of 79%, a positive predictive value of 49%, and a negative predictive value of 91%. The surprise question significantly predicted 1-year mortality in a multivariable model (OR 3.69; 95% CI 1.24-11.02; p = 0.019). The C-statistic of the surprise question to predict mortality was 0.75 (95% CI 0.66-0.85). CONCLUSIONS: The answer on the surprise question can accurately predict 1-year mortality in IPF. Hence, this simple tool may enable timely focus on palliative care for patients with IPF.
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive fatal disease with a heterogeneous disease course. Timely initiation of palliative care is often lacking. The surprise question "Would you be surprised if this patient died within the next year?" is increasingly used as a clinical prognostic tool in chronic diseases but has never been evaluated in IPF. OBJECTIVE: We aimed to evaluate the predictive value of the surprise question for 1-year mortality in IPF. METHODS: In this prospective cohort study, clinicians answered the surprise question for each included patient. Clinical parameters and mortality data were collected. The sensitivity, specificity, accuracy, negative, and positive predictive value of the surprise question with regard to 1-year mortality were calculated. Multivariable logistic regression analysis was performed to evaluate which factors were associated with mortality. In addition, discriminative performance of the surprise question was assessed using the C-statistic. RESULTS: In total, 140 patients were included. One-year all-cause mortality was 20% (n = 28). Clinicians identified patients with a survival of <1 year with a sensitivity of 68%, a specificity of 82%, an accuracy of 79%, a positive predictive value of 49%, and a negative predictive value of 91%. The surprise question significantly predicted 1-year mortality in a multivariable model (OR 3.69; 95% CI 1.24-11.02; p = 0.019). The C-statistic of the surprise question to predict mortality was 0.75 (95% CI 0.66-0.85). CONCLUSIONS: The answer on the surprise question can accurately predict 1-year mortality in IPF. Hence, this simple tool may enable timely focus on palliative care for patients with IPF.
Authors: Kathleen O Lindell; Zhan Liang; Leslie A Hoffman; Margaret Q Rosenzweig; Melissa I Saul; Joseph M Pilewski; Kevin F Gibson; Naftali Kaminski Journal: Chest Date: 2015-02 Impact factor: 9.410
Authors: Zhan Liang; Leslie A Hoffman; Mehdi Nouraie; Daniel J Kass; Michael P Donahoe; Kevin F Gibson; Melissa I Saul; Kathleen O Lindell Journal: J Palliat Med Date: 2016-10-18 Impact factor: 2.947
Authors: Ganesh Raghu; Martine Remy-Jardin; Jeffrey L Myers; Luca Richeldi; Christopher J Ryerson; David J Lederer; Juergen Behr; Vincent Cottin; Sonye K Danoff; Ferran Morell; Kevin R Flaherty; Athol Wells; Fernando J Martinez; Arata Azuma; Thomas J Bice; Demosthenes Bouros; Kevin K Brown; Harold R Collard; Abhijit Duggal; Liam Galvin; Yoshikazu Inoue; R Gisli Jenkins; Takeshi Johkoh; Ella A Kazerooni; Masanori Kitaichi; Shandra L Knight; George Mansour; Andrew G Nicholson; Sudhakar N J Pipavath; Ivette Buendía-Roldán; Moisés Selman; William D Travis; Simon Walsh; Kevin C Wilson Journal: Am J Respir Crit Care Med Date: 2018-09-01 Impact factor: 21.405