<p>A Nomogram for Predicting Severe Exacerbations in Stable COPD Patients</p>

Abstract

Objective: To develop a practicable nomogram aimed at predicting the risk of severe exacerbations in COPD patients at three and five years. Methods: COPD patients with prospective follow-up data were extracted from Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) obtained from National Heart, Lung and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center. We comprehensively considered the demographic characteristics, clinical data and inflammation marker of disease severity. Cox proportional hazard regression was performed to identify the best combination of predictors on the basis of the smallest Akaike Information Criterion. A nomogram was developed and evaluated on discrimination, calibration, and clinical efficacy by the concordance index (C-index), calibration plot and decision curve analysis, respectively. Internal validation of the nomogram was assessed by the calibration plot with 1000 bootstrapped resamples. Results: Among 1711 COPD patients, 523 (30.6%) suffered from at least one severe exacerbation during follow-up. After stepwise regression analysis, six variables were determined including BMI, severe exacerbations in the prior year, comorbidity index, postbronchodilator FEV 1 % predicted, and white blood cells. Nomogram to estimate patients' likelihood of severe exacerbations at three and five years was established. The C-index of the nomogram was 0.74 (95%CI: 0.71-0.76), outperforming ADO, BODE and DOSE risk score. Besides, the calibration plot of three and five years showed great agreement between nomogram predicted possibility and actual risk. Decision curve analysis indicated that implementation of the nomogram in clinical practice would be beneficial and better than aforementioned risk scores. Conclusion: Our new nomogram was a useful tool to assess the probability of severe exacerbations at three and five years for COPD patients and could facilitate clinicians in stratifying patients and providing optimal therapies.

CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care

“…Post-bronchodilator spirometry: Recommended in clinical guidelines to be used in conjunction with clinical assessment to confirm the diagnosis of COPD, 3,22 and is incentivized as part of the 20 and included in several risk prediction tools and models to determine exacerbation risk and/ or mortality risk. 39,40 Low BMI (ie, <21.75 kg/m 2 ) has been associated with increased risk of pneumonia and mortality in COPD patients. 41,42 Obesity, with BMI >30 kg/m 2 , is a risk factor for the development of type II diabetes, 43 a relevant comorbidity for those who frequently exacerbate and require oral corticosteroids (OCS).…”

Scutellarein inhibits BLM-mediated pulmonary fibrosis by affecting fibroblast differentiation, proliferation, and apoptosis

“…GraphPad Software Inc., CA) was used to analyze differences by one-way analysis of variance and to generate graphs. p < 0.05 was considered to indicate statistical significance 22.…”

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“…Women with COPD have a higher prevalence of low BMI than their male counterparts [ 59 ]. Indeed, previous studies have shown that COPD subjects with low BMI have a shorter period of survival [ 99 ] and a greater risk of acute exacerbations with worse airflow limitation, higher level of inflammation biomarkers and poorer health status [ 100 ].…”