The predictive value of an adjusted COPD assessment test score on the risk of respiratory-related hospitalizations in severe COPD patients

Abstract

We evaluated whether a chronic obstructive pulmonary disease (COPD) assessment test (CAT) with adjusted weights for the CAT items could better predict future respiratory-related hospitalizations than the original CAT. Two focus groups (respiratory nurses and physicians) generated two adjusted CAT algorithms. Two multivariate logistic regression models for infrequent (≤1/year) versus frequent (>1/year) future respiratory-related hospitalizations were defined: one with the adjusted CAT score that correlated best with future hospitalizations and one with the original CAT score. Patient characteristics related to future hospitalizations (p ≤ 0.2) were also entered. Eighty-two COPD patients were included. The CAT algorithm derived from the nurse focus group was a borderline significant predictor of hospitalization risk (odds ratio (OR): 1.07; 95% confidence interval (CI): 1.00–1.14; p = 0.050) in a model that also included hospitalization frequency in the previous year (OR: 3.98; 95% CI: 1.30–12.16; p = 0.016) and anticholinergic risk score (OR: 3.08; 95% CI: 0.87–10.89; p = 0.081). Presence of ischemic heart disease and/or heart failure appeared ‘protective’ (OR: 0.17; 95% CI: 0.05–0.62; p = 0.007). The original CAT score was not significantly associated with hospitalization risk. In conclusion, as a predictor of respiratory-related hospitalizations, an adjusted CAT score was marginally significant (although the original CAT score was not). ‘Previous respiratory-related hospitalizations’ was the strongest factor in this equation.

Comparison of Predictive Properties between Tools of Patient-Reported Outcomes: Risk Prediction for Three Future Events in Subjects with COPD

“…The CAT is the PRO measure that is most frequently analyzed as a potential predictor of exacerbation. It has been reported to be capable of predicting exacerbation and hospitalization [ 37 , 38 , 39 , 40 ]. However, since the present study demonstrated that many PRO measurement tools could also predict exacerbation, care should be taken not to overemphasize the benefits of the CAT.…”

A Systematic Literature Review of the Humanistic Burden of COPD

“… 41 However, the CAT score was not associated with increased hospitalization risk. 47 The baseline severity of airflow limitation was an independent determinant for increased CAT score during severe exacerbation (p=0.013). Patients with recurrent hospitalizations showed slower recovery compared with patients hospitalized less frequently over a 3-month observational period.…”

Analysis of the Current State of COPD Nursing Based on a Bibliometric Approach from the Web of Science

“…52 Additionally, studies investigated the needs of patients with COPD and explored the predictors of COPD onset and associated adverse events. 53,54 The research focused on the elderly, while following the evolving concept of person-centered services. Nurses can retrospectively analyze the predictors of adverse events such as readmission and acute exacerbation in patients with COPD through nursing research, provide early interventions for patients who are likely to experience adverse events, contributing to the primary prevention of COPD-related adverse events.…”