Prognostic assessment in COPD without lung function: the B-AE-D indices.
Prognostic assessment in COPD without lung function: the B-AE-D indices.
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DOI：
10.1183/13993003.01485-2015
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发表时间：
2016-06
期刊：
影响因子：
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通讯作者：
Stolz D
中科院分区：
文献类型：
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作者：
Boeck L;Soriano JB;Brusse-Keizer M;Blasi F;Kostikas K;Boersma W;Milenkovic B;Louis R;Lacoma A;Djamin R;Aerts J;Torres A;Rohde G;Welte T;Martinez-Camblor P;Rakic J;Scherr A;Koller M;van der Palen J;Marin JM;Alfageme I;Almagro P;Casanova C;Esteban C;Soler-Cataluña JJ;de-Torres JP;Miravitlles M;Celli BR;Tamm M;Stolz D
已经提出了几种复合标志物用于慢性阻塞性肺疾病（COPD）的风险评估。然而，参数的选择和评分复杂性限制了临床适用性。我们的目的是提供和验证一个简化的COPD风险指数独立于肺功能。PROMISE研究（n=530）被用来开发一种新的预后指数。根据2年COPD相关死亡率和全因死亡率评估指数性能。在ProCOLD、COCOMICS和COMIC队列（总n=2988）的稳定和加重COPD患者中检验外部效度。使用混合临床和统计方法，将体重指数（B）、COPD重度急性加重频率（AE）、改良医学研究理事会呼吸困难严重程度（D）和和肽素（C）确定为最合适的简化标志物组合。将0、1或2分分配给每个参数，并总计为B-AE-D或B-AE-D-C。观察到B-AE-D和B-AE-D-C至少与BODE一样好（体重指数、气流阻塞、呼吸困难、运动能力）、ADO（年龄、呼吸困难、气流阻塞）和剂量（呼吸困难、梗阻、吸烟、加重）预测2年全因死亡率的指数（c-统计量：分别为0.74、0.77、0.69、0.72和0.63; Hosmer-Lemeshow检验均p>0.05）。这两个指数都是COPD特异性的（预测COPD相关2年死亡率的c-统计量分别为0.87和0.89）。在COCOMICS和COMIC中进行了B-AE-D的外部验证（1年全因死亡率的c-统计量：0.68和0.74; 2年全因死亡率的c-统计量：0.65和0.67; Hosmer-Lemeshow检验均p>0.05）。B-AE-D指数，加上和肽素（如果可用），可以简单准确地评估COPD相关风险。B-AE-D指数允许在缺乏肺功能的情况下简单准确地评估COPD相关风险http://ow.ly/XFBox
Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function. The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988). Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer–Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer–Lemeshow test all p>0.05). The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk. The B-AE-D indices allow a simple and accurate assessment of COPD-related risk in the absence of lung function http://ow.ly/XFBox