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Dialysis
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Utility of the “Surprise” Question to Identify Dialysis Patients with High Mortality

Alvin H. Moss, Jesse Ganjoo, Sanjay Sharma, Julie Gansor, Sharon Senft, Barbara Weaner, Cheryl Dalton, Karen MacKay, Beth Pellegrino, Priya Anantharaman and Rebecca Schmidt
CJASN September 2008, 3 (5) 1379-1384; DOI: https://doi.org/10.2215/CJN.00940208
Alvin H. Moss
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Jesse Ganjoo
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Sanjay Sharma
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Julie Gansor
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Sharon Senft
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Barbara Weaner
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Cheryl Dalton
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Karen MacKay
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Beth Pellegrino
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Priya Anantharaman
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Rebecca Schmidt
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    Figure 1.

    Survival curves for “surprise” question response and comorbidity score in days alive at 12 mo. Data are means ± SE. (A) Curves of “yes” and “no” response groups to the “surprise” question, “Would I be surprised if this patient died in the next year?” (B) Curves of the lower (<8) and higher (≥8) Charlson Comorbidity Index (CCI) score groups.

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    Table 1.

    Demographics, quality of life, and prognostic factor scoresa

    VariableAll(n = 147)“Yes”(n = 113)“No”(n = 34)P
    Age (yr)66.4 ± 14.864.5 ± 14.972.5 ± 12.80.005
    Time on dialysis (mo)38.9 ± 38.839.5 ± 41.036.7 ± 30.40.728
    Serum albumin3.9 ± 0.33.9 ± 0.33.7 ± 0.40.046
    Pain visual analogue score2.6 ± 3.22.7 ± 3.32.3 ± 3.00.575
    McGill Quality of Life Question6.7 ± 2.16.8 ± 2.16.4 ± 2.00.394
    CCI score6.1 ± 2.25.8 ± 2.17.1 ± 2.30.004
    Karnofsky Performance Status score80.0 ± 16.881.6 ± 15.869.7 ± 17.1<0.001
    • ↵a “Yes” indicates patients in the “yes, I would be surprised” group; “No” indicates the “no, I would not be surprised” group. CCI, Charlson Comorbidity Index.

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    Table 2.

    Univariate logistic regression analysis to predict status at 12 moa

    PredictorOR (95% CI)P
    “Surprise” question response (reference = “yes”)3.507 (1.356 to 9.067)0.010
    CCI score1.417 (1.099 to 1.826)0.007
    Karnofsky Performance Status score0.964 (0.937 to 0.992)0.012
    Quality of Life score0.859 (0.693 to 1.065)0.166
    Visual analogue scale1.109 (0.962 to 1.279)0.153
    Serum albumin0.329 (0.080 to 1.350)0.123
    Mean Kt/V1.242 (0.238 to 6.489)0.797
    Serum hemoglobin1.084 (0.692 to 1.699)0.724
    Gender0.974 (0.392 to 2.420)0.955
    Race0.324 (0.041 to 2.580)0.287
    Time on dialysis (mo)1.006 (0.995 to 1.016)0.293
    Age1.012 (0.980 to 1.045)0.469
    • ↵a CI, confidence interval; OR, odds ratio. For those for whom the “surprise” question was answered “no,” the odds of dying within 1 yr were 3.507 times the odds of dying for those for whom the “surprise” question response was “yes.” CCI indicates Charlson Comorbidity Index.

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    Table 3.

    Multivariate logistic regression analysis to predict status at 12 mo

    PredictorOR (95% CI)P
    “Surprise” question (reference = “yes”)2.448 (0.653 to 9.170)0.184
    CCI score1.511 (1.047 to 2.181)0.027
    Karnofsky Performance Status score0.985 (0.949 to 1.024)0.449
    Quality of Life score0.972 (0.720 to 1.313)0.854
    Visual analogue scale1.080 (0.908 to 1.283)0.384
    Serum albumin0.681 (0.111 to 4.165)0.677
    Mean Kt/V1.470 (0.216 to 10.014)0.694
    Serum hemoglobin1.344 (0.699 to 2.582)0.376
    Gender0.826 (0.225 to 3.028)0.773
    Race0.442 (0.044 to 4.423)0.488
    Time on dialysis1.010 (0.997 to 1.023)0.122
    Age0.962 (0.911 to 1.016)0.160
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Clinical Journal of the American Society of Nephrology
Vol. 3, Issue 5
September 2008
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Utility of the “Surprise” Question to Identify Dialysis Patients with High Mortality
Alvin H. Moss, Jesse Ganjoo, Sanjay Sharma, Julie Gansor, Sharon Senft, Barbara Weaner, Cheryl Dalton, Karen MacKay, Beth Pellegrino, Priya Anantharaman, Rebecca Schmidt
CJASN Sep 2008, 3 (5) 1379-1384; DOI: 10.2215/CJN.00940208

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Utility of the “Surprise” Question to Identify Dialysis Patients with High Mortality
Alvin H. Moss, Jesse Ganjoo, Sanjay Sharma, Julie Gansor, Sharon Senft, Barbara Weaner, Cheryl Dalton, Karen MacKay, Beth Pellegrino, Priya Anantharaman, Rebecca Schmidt
CJASN Sep 2008, 3 (5) 1379-1384; DOI: 10.2215/CJN.00940208
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