title: Care dependency independently predicts two-year survival in outpatients with advanced chronic organ failure.
abstract: OBJECTIVE
  Previous studies suggest that care dependency may predict survival in hospitalized patients, but the prognostic value of care dependency in clinically stable outpatients with advanced chronic organ failure remains unknown. The objective of this study was to assess whether and to what extent care dependency predicts 2-year survival in patients with advanced chronic organ failure.
  
  
  METHODS
  Longitudinal observational study.
  
  
  METHODS
  Patients were recruited at the outpatient clinic of one academic and six general hospitals in The Netherlands.
  
  
  METHODS
  A total of 265 clinically stable outpatients with advanced chronic obstructive pulmonary disease (n = 105), chronic heart failure (n = 80), and chronic renal failure (n = 80) were included at baseline.
  
  
  METHODS
  Care dependency was assessed using the Care Dependency Scale (CDS), a 15-item self-administered questionnaire. In addition, patients performed a Timed Up and Go test to assess mobility. Finally, demographics, clinical characteristics, and 2-year survival were recorded.
  
  
  RESULTS
  At baseline, 116 patients (43.8%) reported a CDS score ≤ 68 points and were considered as care dependent. In total, 66 patients (24.9%) died within 2 years. The Cox regression model showed that a higher CDS score (lower level of care dependency) was associated with a lower probability of dying within 2 years (hazard ratio, 0.95; 95% CI: 0.90-0.97), whereas older age was associated with a greater probability of dying within 2 years (hazard ratio, 1.06; 95% CI, 1.03-1.09).
  
  
  CONCLUSIONS
  The level of care dependency independently predicts 2-year survival among clinically stable outpatients with advanced chronic organ failure. Therefore, regular assessment of the level of care dependency should be included in clinical care for patients with advanced chronic organ failure.
authors.affiliation: Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands. daisyjanssen@ciro-horn.nl
authors.forename: Daisy J A
authors.initials: DJ
authors.lastname: Janssen
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.forename: Jos M G A
authors.initials: JM
authors.lastname: Schols
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010045:Outpatients; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000628:therapy*; D011795:Surveys and Questionnaires; D015996:Survival Rate