External validation of multidimensional prognostic indices (ADO, BODEx and DOSE) in a primary care international cohort (PROEPOC/COPD cohort)

Abstract

BackgroundDue to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014). Besides, we want to confirm that the prognostic capacity of all indices increases if the number of exacerbations is substituted by the interval between them and to assess the impact on health of the patient’s lifestyle, social network and adherence to treatment.MethodsDesign: External validation of scales, open and prospective cohort study in primary care.Setting: 36 health centres in 6 European high, medium and low income countries.Subjects: 477 patients diagnosed with COPD, captured in clinical visit by their General Practitioner/Nurse.Predictors: Detailed patient history, exacerbations, lung function test and questionnaires at baseline.Outcomes: Exacerbations, all-cause mortality and specific mortality, within 5 years of recruitment.Analysis: Multivariate logistic regression and Cox regression will be used. Possible non-linear effect of the indices will be studied by using Structured Additive Regression models with penalised splines. Subsequently, we will assess different aspects of the regression models: discrimination, calibration and diagnostic precision. Clinical variables modulated in primary care and the interval between exacerbations will be considered and incorporated into the analysis.DiscussionThe Research Agenda for General Practice/Family Medicine highlights that the evidence on predictive values of prognostic indices in primary care is scarce. A prospective cohort like that of PROEPOC/COPD provides good opportunities for research into COPD and make communication easier between family practitioners, nursing staff, pneumologists and other professionals, supporting a multi-disciplinary approach to the treatment of these patients.Trial registration ISRCTN52402811. Date: 15/01/2015. Prospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0305-2) contains supplementary material, which is available to authorized users.

External validation of ADO, DOSE, COTE and CODEX at predicting death in primary care patients with COPD using standard and machine learning approaches

“…[15] However, larger cohorts are required to properly evaluate the predictive performance of these risk scores in primary care patients. [16] The aim of this study was to evaluate several existing risk scores for mortality in COPD over multiple time periods with a large representative COPD population from primary care, using both traditional and a machine learning approach.…”

Protocol for the EARCO Registry: a pan-European observational study in patients with α1-antitrypsin deficiency

“…Composite scores that combine different physiological measures are used to assess the severity and prognosis of obstructive lung disease and liver disease, but the experience in AATD is very limited [57]. We will use the BODE [38] and BODEx [39] for lung disease and the Fibrosis-4 [57] for liver disease to assess their values in monitoring and determining long-term prognosis in AATD.…”

“…The body mass index, obstruction, dyspnoea and exercise (BODE) and the Body mass index, Obstruction, Dyspnoea and Exacerbations (BODEx) indices will be calculated automatically from entered and quality-controlled data [38,39].…”

Chronic Obstructive Pulmonary Disease and the Optimal Timing of Lung Transplantation

“…Severe exacerbations of COPD are variably defined in the literature [29]. They are, however, invariably associated with increased mortality [30,31]. Patients who survive to discharge after being admitted to the hospital for a COPD exacerbation have a two-year mortality between 20% for general floor admission and 50% for patients with hypercapnic respiratory failure or need for mechanical ventilation.…”