The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients
The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients
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DOI：
10.1016/j.rmed.2013.12.014
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发表时间：
2014-04-01
影响因子：
4.3
通讯作者：
Sajkov, Dimitar
中科院分区：
文献类型：
--
作者：
Lee, Sang-Do;Huang, Ming-Shyan;Sajkov, Dimitar
我们评估了COPD评估测试(CAT(TM))对既往有加重病史的COPD患者在接下来的6个月内或首次加重的时间的预测价值。基线CAT评分分为4组(0-9、10-19、20-29和30-40)，对首次发作的时间有很强的预测作用，对任何加重或中-重度加重有适度的预测(AUC分别为0.83、0.64和0.63)。在多变量分析中，分类后的CAT评分独立预测了所有三种结果(p=0.001或p<；0.001)。与CAT评分最低的类别相比，类别越高，首次病情恶化的时间越短，病情恶化的风险越高。相应的调整中位时间为24、14、9和5周，0-9、10-19、20-29和30-40的调整RR分别为1.00、1.30、1.37和1.50。急性加重病史(在过去一年中=2比1)与首次恶化的时间(调整后的HR1.35；p=0.023)和研究期间的任何恶化(调整后的RR 1.15；p=0.016)有关。这项研究的结果支持使用CAT作为一种简单的工具来帮助识别具有更高恶化风险的患者。这可以促进及时和具有成本效益的预防干预措施的实施，并改善卫生资源分配。试验注册：ClinicalTrials.gov：NCT01254032。(C)2014年提交人。爱思唯尔有限公司出版。保留所有权利。
We evaluated the predictive value of the COPD assessment test (CAT (TM)) for exacerbation in the following six months or time to first exacerbation among COPD patients with previous exacerbations.COPD outpatients with a history of exacerbation from 19 hospitals completed the CAT questionnaire and spirometry over six months. Exacerbation events were prospectively collected using a structured questionnaire.The baseline CAT score categorised into four groups (0-9, 10-19, 20-29, and 30-40) showed strong prediction for time to first exacerbation and modest prediction for any exacerbation or moderate-severe exacerbation (AUC 0.83, 0.64, and 0.63 respectively). In multivariate analyses, the categorised CAT score independently predicted all three outcomes (p = 0.001 or p < 0.001). Compared with the lowest CAT score category, the higher categories were associated with significantly shorter time to first exacerbation and higher exacerbation risks. The corresponding adjusted median time was >24, 14, 9, and 5 weeks and the adjusted RR was 1.00, 1.30, 1.37, and 1.50 in the category of 0-9, 10-19, 20-29, and 30-40 respectively. Exacerbation history (>= 2 vs. 1 event in the past year) was related to time to first exacerbation (adjusted HR 1.35; p = 0.023) and any exacerbation during the study period (adjusted RR 1.15; p = 0.016).The results of this study support the use of the CAT as a simple tool to assist in the identification of patients at increased risk of exacerbations. This could facilitate timely and cost-effective implementation of preventive interventions, and improve health resource allocation.Trial registration: Clinicaltrials.gov: NCT01254032. (C) 2014 The Authors. Published by Elsevier Ltd. All rights reserved.