Development and Validation of Prediction Models for Exacerbation, Frequent Exacerbations and Severe Exacerbations of Chronic Obstructive Pulmonary Disease: A Registry Study in North China

Abstract

In COPD patients, exacerbation has a detrimental influence on the quality of life, disease progression and socioeconomic burden. This study aimed to develop and validate models to predict exacerbation, frequent exacerbations and severe exacerbations in COPD patients. We conducted an observational prospective multicenter study. Clinical data of all outpatients with stable COPD were collected from Beijing Chaoyang Hospital and Beijing Renhe Hospital between January 2018 and December 2019. Patients were followed up for 1 year. The data from Chaoyang Hospital was used for modeling dataset, and that of Renhe Hospital was used for external validation dataset. The final dataset included 456 patients, with 326 patients as the model group and 130 patients as the validation group. Using LABA + ICS, frequent exacerbations in the past year and CAT score were independent risk factors for exacerbation in the next year (OR = 2.307, 2.722 and 1.147), and FVC %pred as a protective factor (OR = 0.975). Combined with chronic heart failure, frequent exacerbations in the past year, blood EOS counts and CAT score were independent risk factors for frequent exacerbations in the next year (OR = 4.818, 2.602, 1.015 and 1.342). Using LABA + ICS, combined with chronic heart failure, frequent exacerbations in the past year and CAT score were independent risk factors for severe exacerbations in the next year (OR = 1.950, 3.135, 2.980 and 1.133). Based on these prognostic models, nomograms were generated. The prediction models were simple and useful tools for predicting the risk of exacerbation, frequent exacerbations and severe exacerbations of COPD patients in North China.

Keywords:

• Prediction models
• exacerbation
• chronic obstructive pulmonary disease

Ethics statement

All patients provided informed consent. The Ethics Committee of Beijing Chao-Yang Hospital (2017-KE-92) approved the collection of clinical data from the patients.

Authors’ contributions

Authorship and contributorship: All authors made a significant contribution to the work. Z.Y. and H.S. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Z. Y., B. X. contributed to the conception and design of the study; H.S., W. W., W. X., L. D., C. X. contributed to the performing of the study; H.S., W. W., W. X., L. D., C. X. drafted of the manuscript for important intellectual content; Z. Y., H.S., B. X. contributed to the data analysis; Z. Y., H.S. and B. X. contributed to the writing of the paper; All coauthors revised the work critically for important intellectual content, agreed on the journal to which the article has been submitted, gave final approval for this version to be published and agreed to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

Additional information

Funding

The work reported here was supported by the Beijing Capital Health Development and Scientific Research Project under Grant [2018-2-1062].