Prediction of Mortality Using Different COPD Risk Assessments – A 12-Year Follow-Up
Received 3 November 2020
Accepted for publication 1 February 2021
Published 16 March 2021 Volume 2021:16 Pages 665—675
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Åsa Athlin,1 Maaike Giezeman,1,2 Mikael Hasselgren,1 Scott Montgomery,3– 5 Karin Lisspers,6 Björn Ställberg,6 Christer Janson,7 Josefin Sundh8
1School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 2Centre for Clinical Research, Region Värmland, Karlstad, Sweden; 3Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, S-701 82, Sweden; 4Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; 5Department of Epidemiology and Public Health, University College, London, UK; 6Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden; 7Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden; 8Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Correspondence: Åsa Athlin Vallgatan 17, Fjugesta, S-716 31, Sweden
Tel +4670 2265976
Email [email protected]
Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices.
Patients and Methods: A total of 490 patients diagnosed with COPD were recruited from primary and secondary care in central Sweden in 2005. The cohort was followed until 2017. Data for categorization using the different assessment systems were obtained through questionnaire data from 2005 and medical record reviews between 2000 and 2003. Kaplan-Meier survival analyses and Cox proportional hazard models were used to assess mortality risk. Receiver operating characteristic curves estimated areas under the curve (AUC) to evaluate each assessment systems´ ability to predict mortality.
Results: By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3– 4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75– 0.83) for all-cause mortality and 0.80 (95% CI 0.75– 0.85) for respiratory mortality. The AUC values for stages 1– 4, GOLD 2011, GOLD 2017 and DOSE index were 0.73, 0.66, 0.63 and 0.69, respectively, for all-cause mortality.
Conclusion: All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.
Keywords: chronic obstructive pulmonary disease, GOLD classification, ADO index, DOSE index, prediction, mortality
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