| アブストラクト | INTRODUCTION: Efficient preventive management of acute exacerbation of chronic obstructive pulmonary disease (COPD) is predicated on accurate risk stratification. We compared the performance of exacerbation history (current standard of care) versus a revised version of a multivariable risk scoring tool (Acute COPD Exacerbation Prediction Tool (ACCEPT)) using primary-care UK data. METHODS: We used validated case definitions to identify diagnosed patients with COPD >/=40 years old from the UK Clinical Practice Research Datalink Aurum (2004-2020). For each patient, a single annual COPD visit was randomly selected as the index date. The outcome was the occurrence of >/=1 moderate/severe exacerbation(s) within a year of the index date. We conducted time-to-event analyses of the latest version of ACCEPT (ACCEPT 2.0) and developed a recalibrated version (ACCEPT 3.0-UK). Model performance was evaluated using discrimination (time-dependent area under the receiver operating characteristic curve (AUC)), calibration and net benefit. RESULTS: The final cohort included 158 384 patients (55.0% male; mean age 71.5 years). ACCEPT 2.0 achieved an AUC of 0.77 for predicting moderate/severe exacerbations, outperforming both any and frequent exacerbator categories (AUC: 0.69 and 0.67, respectively). However, it overpredicted exacerbation events (observed-to-expected (O/E) ratio: 0.81 (95% CI 0.80 to 0.81)). Recalibration resolved this overprediction, yielding O/E ratio of 1.00 (95% CI 0.99 to 1.00), while maintaining discrimination (AUC: 0.77). ACCEPT 3.0-UK was net beneficial and superior to exacerbation history across a wide range of risk thresholds. CONCLUSION: ACCEPT 3.0-UK has substantially higher performance than exacerbation history, quantifies predicted risks for shared decision-making and is likely to confer clinical utility for risk stratification in primary care. |
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| 投稿者 | Mehareen, Jeenat; Lim, Laura Huey Mien; Adibi, Amin; Amegadzie, Joseph Emil; Xia, Yuan; De Vera, Mary A; Law, Michael R; Sin, Don D; Bhatt, Surya P; Quint, Jennifer K; Sadatsafavi, Mohsen |
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| 組織名 | The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver,;British Columbia, Canada.;Saw Swee Hock School of Public Health, National University of Singapore,;Singapore.;BCCDC, Vancouver, British Columbia, Canada.;Department of Statistics, The University of British Columbia, Vancouver, British;Columbia, Canada.;Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada.;Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.;Centre for Health Policy, University of Calgary, Calgary, Alberta, Canada.;The University of British Columbia Centre for Heart Lung Innovation, Vancouver,;Center for Lung Analytics and Imaging Research, and Division of Pulmonary,;Allergy and Critical Care Medicine, The University of Alabama at Birmingham,;Birmingham, Alabama, USA.;NHLI, Imperial College London, London, UK.;British Columbia, Canada mohsen.sadatsafavi@ubc.ca. |
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