Health Status Instruments Add Prognostic Value in Predicting COPD Exacerbations: Insights from the TIE Cohort Study.

IF 2.8 4区医学 Q3 RESPIRATORY SYSTEM

COPD: Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2025-12-01 Epub Date: 2025-12-04 DOI:10.1080/15412555.2025.2589129

Andreas Palm, Jens Ellingsen, Kristina Bröms, Amir Farkhooy, Marieann Högman, Karin Lisspers, Björn Ställberg, Christer Janson, Andrei Malinovschi, Maria Hårdstedt

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引用次数: 0

Abstract

Aim: Identifying patients at risk for acute exacerbations of COPD (AECOPDs) is crucial to improve outcomes. We aimed to evaluate the ability of three health status instruments to predict AECOPDs in subjects with and without previous AECOPDs.

Methods: A prospective cohort study of COPD patients from primary and outpatient care in three Swedish regions. AECOPDs were retrieved from medical records. The modified Medical Research Council Dyspnoea scale (mMRC), the COPD Assessment Test (CAT), and the Clinical COPD Questionnaire (CCQ) were evaluated. Thresholds for AECOPD prediction were estimated using receiver operator characteristic (ROC) curves. Predictive values were assessed using crude and multivariable Cox regression models.

Results: We included 572 patients (59% women, age 69 ± 8 years, FEV₁ 57 ± 18% of predicted) in 2014-2016. All three instruments independently predicted future AECOPDs within three years (adjusted hazard ratio [aHR] 1.5-1.8) using thresholds mMRC ≥ 2, CAT ≥13, and CCQ ≥ 1.6. Patients without prior-year AECOPDs but high scores on all instruments had a similar AECOPD risk as those with prior AECOPDs but scores below threshold (aHR 2.4-2.5). Among patients with ≥1 AECOPD the year before inclusion and at least one of the three health status instruments above threshold, the aHR for future AECOPD during the study period ranged from 4.6 to 5.7.

Conclusions: mMRC, CAT, and CCQ were independently associated with AECOPDs over the following three-year period. The health status instruments provided additional predictive value for future AECOPDS in patients both with and without previous AECOPDs.

Abbreviations: aHR: Adjusted Hazard Ratio; AECOPD: Acute Exacerbations of Chronic Obstructive Pulmonary Disease; AUC: Area Under Curve; BMI: Body Mass Index; CAT: COPD Assessment Test; CCQ: Clinical COPD Questionnaire; COPD: Chronic Obstructive Pulmonary Disease; DAG: Directed Acyclic Graphs; FEV1: Forced Expiratory Volume in 1 Second; FVC: Forced Vital Capacity; GOLD: Global Initiative for Obstructive Lung Disease; HR: Hazard Ratio; IHD: Ischaemic Heart Disease; ICS: Inhaled Corticosteroids; IQR: Interquartile Range; mMRC: Modified Medical Research Council Dyspnoea Scale; ROC: Receiver Operator Characteristic; SD: Standard Deviation; TIE: Tools for Identifying Exacerbations.

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健康状况仪器在预测COPD恶化中增加预后价值：来自TIE队列研究的见解

目的：识别COPD急性加重（AECOPDs）风险患者对改善预后至关重要。我们的目的是评估三种健康状况工具在有和没有aecopd的受试者中预测aecopd的能力。方法：对来自瑞典三个地区的初级和门诊治疗的COPD患者进行前瞻性队列研究。从医疗记录中检索aecopd。采用改良的医学研究委员会呼吸困难量表（mMRC）、慢阻肺评估测试（CAT）和临床慢阻肺问卷（CCQ）进行评估。采用受试者操作特征（ROC）曲线估计AECOPD预测阈值。使用粗糙和多变量Cox回归模型评估预测值。结果：我们纳入了2014-2016年572例患者（59%为女性，年龄69±8岁，FEV1为预测的57±18%）。使用阈值mMRC≥2、CAT≥13和CCQ≥1.6，这三种仪器均独立预测三年内未来aecopd（校正风险比[aHR] 1.5-1.8）。既往无AECOPD但所有仪器评分较高的患者与既往有AECOPD但评分低于阈值（aHR 2.4-2.5）的患者具有相似的AECOPD风险。在纳入前一年AECOPD≥1且三项健康状况指标中至少有一项高于阈值的患者中，研究期间未来AECOPD的aHR范围为4.6至5.7。结论：mMRC、CAT和CCQ与AECOPDs在接下来的三年时间里独立相关。健康状况仪器为有或无AECOPDS患者未来AECOPDS提供了额外的预测价值。aHR：调整风险比；AECOPD：慢性阻塞性肺疾病急性加重；AUC：曲线下面积；BMI：身体质量指数；CAT: COPD评估试验；CCQ：临床COPD问卷；慢性阻塞性肺疾病；DAG：有向无环图；FEV1: 1秒用力呼气量；FVC：强制肺活量；GOLD：全球阻塞性肺病倡议；HR：风险比；缺血性心脏病；ICS：吸入皮质类固醇；IQR：四分位间距；mMRC：改良的医学研究委员会呼吸困难量表；ROC：接收算子特征；SD：标准差；TIE：识别恶化的工具。

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来源期刊

COPD: Journal of Chronic Obstructive Pulmonary Disease RESPIRATORY SYSTEM-

CiteScore

4.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： From pathophysiology and cell biology to pharmacology and psychosocial impact, COPD: Journal Of Chronic Obstructive Pulmonary Disease publishes a wide range of original research, reviews, case studies, and conference proceedings to promote advances in the pathophysiology, diagnosis, management, and control of lung and airway disease and inflammation - providing a unique forum for the discussion, design, and evaluation of more efficient and effective strategies in patient care.