Dataset Information

Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts.

ABSTRACT:

Background

Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists.

Objective

To conduct a large international study to validate the ADO index that uses age, dyspnoea and FEV(1) to predict 3-year mortality and to update it in order to make prediction of mortality in COPD patients as generalisable as possible.

Design

Individual subject data analysis of 10 European and American cohorts (n=13 914).

Setting

Population-based, primary, secondary and tertiary care.

Patients

COPD GOLD stages I-IV.

Measurements

We validated the original ADO index. We then obtained an updated ADO index in half of our cohorts to improve its predictive accuracy, which in turn was validated comprehensively in the remaining cohorts using discrimination, calibration and decision curve analysis and a number of sensitivity analyses.

Results

1350 (9.7%) of all subjects with COPD (60% male, mean age 61 years, mean FEV(1) 66% predicted) had died at 3 years. The original ADO index showed high discrimination but poor calibration (p<0.001 for difference between predicted and observed risk). The updated ADO index (scores from 0 to 14) preserved excellent discrimination (area under curve 0.81, 95% CI 0.80 to 0.82) but showed much improved calibration with predicted 3-year risks from 0.7% (95% CI 0.6% to 0.9%, score of 0) to 64.5% (61.2% to 67.7%, score of 14). The ADO index showed higher net benefit in subjects at low-to-moderate risk of 3-year mortality than FEV(1) alone.

Interpretation

The updated 15-point ADO index accurately predicts 3-year mortality across the COPD severity spectrum and can be used to inform patients about their prognosis, clinical trial study design or benefit harm assessment of medical interventions.

SUBMITTER: Puhan MA

PROVIDER: S-EPMC3533065 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Publications

Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts.

Puhan Milo A MA Hansel Nadia N NN Sobradillo Patricia P Enright Paul P Lange Peter P Hickson Demarc D Menezes Ana M AM ter Riet Gerben G Held Ulrike U Domingo-Salvany Antonia A Mosenifar Zab Z Antó Josep M JM Moons Karel G M KG Kessels Alphons A Garcia-Aymerich Judith J

BMJ open 20121212 6

<h4>Background</h4>Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists.<h4>Objective</h4>To conduct a large international study to validate the ADO index that uses age, dyspnoea and FEV(1) to predict 3-year mortality and to update it in order to make prediction of mortality in COPD patients as generalisable as possible.<h4>Design</h4>Individual subject data analysis of 10 European and Amer ...[more]

PMID: 23242246

Similar Datasets

Project description:Chronic Obstructive Pulmonary Disease (COPD) is a systemic disease; morbidity and mortality due to COPD are on the increase, and it has great impact on patients' lives. Most COPD patients are managed by general practitioners (GP). Too often, GPs base their initial assessment of patient's disease severity mainly on lung function. However, lung function correlates poorly with COPD-specific health-related quality of life and exacerbation frequency. A validated COPD disease risk index that better represents the clinical manifestations of COPD and is feasible in primary care seems to be useful. The objective of this study is to develop and validate a practical COPD disease risk index that predicts the clinical course of COPD in primary care patients with GOLD stages 2-4.We will conduct 2 linked prospective cohort studies with COPD patients from GPs in Switzerland and the Netherlands. We will perform a baseline assessment including detailed patient history, questionnaires, lung function, history of exacerbations, measurement of exercise capacity and blood sampling. During the follow-up of at least 2 years, we will update the patients' profile by registering exacerbations, health-related quality of life and any changes in the use of medication. The primary outcome will be health-related quality of life. Secondary outcomes will be exacerbation frequency and mortality. Using multivariable regression analysis, we will identify the best combination of variables predicting these outcomes over one and two years and, depending on funding, even more years.Despite the diversity of clinical manifestations and available treatments, assessment and management today do not reflect the multifaceted character of the disease. This is in contrast to preventive cardiology where, nowadays, the treatment in primary care is based on patient-specific and fairly refined cardiovascular risk profile corresponding to differences in prognosis. After completion of this study, we will have a practical COPD-disease risk index that predicts the clinical course of COPD in primary care patients with GOLD stages 2-4. In a second step we will incorporate evidence-based treatment effects into this model, such that the instrument may guide physicians in selecting treatment based on the individual patients' prognosis.ClinicalTrials.gov Archive NCT00706602.

Dataset Information

Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts.

Background

Objective

Design

Setting

Patients

Measurements

Results

Interpretation

Publications

Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts.

Similar Datasets

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