Researchers have found a new method that helps personalise therapy to patients beyond severe pulmonary disorder diagnosis alone and provides additional risk information to physicians.

The study will be presented at the annual international conference of the American Thoracic Society. The Laboratory-based Intermountain Validated Exacerbation (LIVE) score is a prediction model that predicts all-cause mortality, morbidity, and hospitalisation rates for patients with chronic obstructive pulmonary disease (COPD), a chronic, progressive lung disease that gradually makes it hard to breathe.

The LIVE score combines a patient's simple laboratory values (levels of haemoglobin, albumin, creatinine, chloride, and potassium) to identify patients who are at high risk of death or further disease advancement, and who may most need referrals to palliative care and advanced care planning resources.

In the study, Intermountain Healthcare researchers calculated the LIVE scores of 17,124 patients with COPD.
They found that patients with high-risk LIVE scores had the highest one-year mortality rates (39.4 per cent) and the highest rate of palliative care referrals (41.7 per cent). In comparison, patients with the lowest risk LIVE scores had 0.7 per cent all cause one-year mortality and 0.7 per cent palliative care referral rate.

"We found the LIVE score helps personalise therapy to patients beyond the COPD diagnosis alone and provides additional risk information to both patients and their doctors. From a population health perspective, the LIVE score allows for designing pathways of care that identify and treat patients based on individual risk beyond a single diagnosis label alone," said Denitza Blagev, the study's lead author.

Researchers said the findings can help physicians determine which of their COPD patients are at highest risk, and who may benefit from palliative care and appropriate end-of-life services. Palliative care focuses on relief from the symptoms of a serious disease, rather than on a cure, and is often provided in the final stages of a patient's life.

While patients with COPD, in general, are considered high risk, there is a lot of variability in the risk of death for a particular patient with a COPD diagnosis. By using the LIVE score clinicians can design health system interventions that assess high-risk patients for palliative care evaluation.

"By exploring the association of palliative care referrals and LIVE score risk, this study is a step forward in understanding how the LIVE score may be used to target appropriate patient care," said Dr Blagev.

"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," she 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," said Dr Blagev.

For example, for a COPD patient with a low-risk LIVE score, interventions aimed at optimising COPD management may be most effective, as the risk of other diseases and death is relatively low. In contrast, a patient with a high-risk LIVE score may see benefit from COPD-directed therapy but may find even more improvement with the management of their other diseases, which contribute to the risk of death.