The value of the surprise question to predict mortality in idiopathic pulmonary fibrosis

Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive fatal disease with an unpredictable disease course. Timely initiation of palliative care (PC) and advance care planning are often lacking. In other diseases the Surprise Question (SQ) is used to predict mortality: 9Would you be surprised if this patient died in the next year?9 We assessed the predictive value of the SQ for 1-year mortality in IPF to allow for timely focus on PC. Methods: Outpatients with IPF were included in this prospective, observational study. Healthcare providers (HCPs) answered the SQ. Baseline parameters and mortality rate after one year were collected. Univariable logistic regression was used to evaluate predictive factors for 1-year mortality. Results: 123 IPF patients were included: 88% male, mean age 74 (SD 6.3), mean FVC 73% of predicted (SD 18.2), DLCO 38% of predicted (SD 13.5), 40% used oxygen, 53% had cardiovascular disease (CVD) and 22% diabetes. HCPs answered the SQ with ‘no’ for 33 patients. 19% of IPF patients died within 1-year. The sensitivity of the SQ to predict mortality was 74%, the specificity 84%, the positive predictive value 52% and the negative predictive value 93%. The odds ratio (OR) of 1-year mortality for the patients in the ‘not surprised’ group was 14.3 (CI 4.9-41.6 p Conclusion: SQ seems to predict 1-year mortality better than other clinical parameters. This simple tool may enable timely focus on PC for IPF patients.