Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts.
Ten-year prediction model for post-bronchodilator airflow obstruction and early detection of COPD: development and validation in two middle-aged population-based cohorts.
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DOI：
10.1136/bmjresp-2021-001138
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发表时间：
2021-12
影响因子：
4.1
通讯作者：
TAHS and ECRHS Investigator Groups
中科院分区：
文献类型：
--
作者：
Perret JL;Vicendese D;Simons K;Jarvis DL;Lowe AJ;Lodge CJ;Bui DS;Tan D;Burgess JA;Erbas B;Bickerstaffe A;Hancock K;Thompson BR;Hamilton GS;Adams R;Benke GP;Thomas PS;Frith P;McDonald CF;Blakely T;Abramson MJ;Walters EH;Minelli C;Dharmage SC;TAHS and ECRHS Investigator Groups
对慢性阻塞性肺疾病（COPD）高危人群进行分类，为早期COPD检测和积极干预创造了机会。开发并验证一种统计模型，以预测COPD的10年概率，COPD定义为支气管扩张剂后气流阻塞（BD-AO后; 1秒用力呼气量/用力肺活量<第5百分位数）。来自澳大利亚和欧洲的一般高加索人群，分别为10个和27个中心。对于开发队列，关于呼吸道症状、吸烟、哮喘、职业和参与者性别的问卷数据来自塔斯马尼亚纵向健康研究（TAHS）参与者，年龄为41-45岁（n=5729），这些参与者在基线时没有自我报告的COPD/肺气肿，但在51-55岁（n=2407）时有BD后肺量测定和吸烟状态。验证队列包括来自欧洲共同体呼吸健康调查（ECRHS）II和III的受试者（n=5970），分别限于年龄为40-49岁和50-59岁的受试者（n=1407），具有完整的问卷和肺量测定/吸烟数据。风险预测模型使用randomForest开发，然后进行外部验证。最终模型的受试者工作特征曲线下面积（AUCROC）为80.8%（95% CI 80.0%至81.6%），灵敏度80.3%（77.7%~ 82.9%），特异性69.1%阳性预测值（PPV）为11.1%（10.3%~ 11.9%），阴性预测值（NPV）为98.7%（98.5%~ 98.9%）。外部验证是公平的（AUCROC 75.6%），对于年龄40-49岁且有≥1种呼吸道症状的成人，PPV增加至17.9%，NPV仍为97.5%。为了使用假设的病例场景来说明模型输出，一名43岁的女性非熟练工人每天吸烟20支，持续30年，如果她继续吸烟，则在53岁时发生后BD-AO的预测概率为27%。如果她同时患有活动性哮喘，预测风险为42%，但如果她在43岁后戒烟，则只有4.5%。这种新的和验证的风险预测模型可以识别40多岁的成年人在一般人群中的高10年COPD风险，有可能促进在更早的年龄预测的“COPD病例”的主动监测/干预。
Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention. To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile). General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively. For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41–45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51–55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40–49 and 50–59 with complete questionnaire and spirometry/smoking data, respectively (n=1407). Risk-prediction models were developed using randomForest then externally validated. Area under the receiver operating characteristic curve (AUCROC) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUCROC 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40–49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43. This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted ‘COPD cases’ at a much earlier age.
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影响因子：
168.9
作者：
D'Ascenzo, Fabrizio;De Filippo, Ovidio;De Ferrari, Gaetano Maria
通讯作者：
De Ferrari, Gaetano Maria
影响因子：
7.7
作者：
Matheson, Melanie C.;Abramson, Michael J.;Dharmage, Shyamali C.
通讯作者：
Dharmage, Shyamali C.
影响因子：
3.7
作者：
Bedard, Annabelle;Carsin, Anne-Elie;Garcia-Aymerich, Judith
通讯作者：
Garcia-Aymerich, Judith
影响因子：
10
作者：
Lambe, Tosin;Adab, Peymane;Jowett, Sue
通讯作者：
Jowett, Sue
影响因子：
24.3
作者：
Miller, MR;Hankinson, J;Wanger, J
通讯作者：
Wanger, J