A score to predict short-term risk of COPD exacerbations (SCOPEX)

Barry J Make, Göran Eriksson, Peter M Calverley, Christine R Jenkins, Dirkje S Postma, Stefan Peterson, Ollie Östlund, Antonio Anzueto, Barry J Make, Göran Eriksson, Peter M Calverley, Christine R Jenkins, Dirkje S Postma, Stefan Peterson, Ollie Östlund, Antonio Anzueto

Abstract

Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year.

Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0-100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC) curves and the corresponding C-index were used to investigate the discriminatory properties of predictive variables.

Results: The best predictors of an exacerbation in the next 6 months were more COPD maintenance medications prior to the trial, higher mean daily reliever use, more exacerbations during the previous year, lower forced expiratory volume in 1 second/forced vital capacity ratio, and female sex. Using these risk variables, we developed a score to predict short-term (6-month) risk of COPD exacerbations (SCOPEX). Budesonide/formoterol reduced future exacerbation risk more than formoterol or as-needed short-acting β2-agonist (salbutamol).

Conclusion: SCOPEX incorporates easily identifiable patient characteristics and can be readily applied in clinical practice to target therapy to reduce COPD exacerbations in patients at the highest risk.

Trial registration: ClinicalTrials.gov NCT00206154 NCT00206167 NCT00419744.

Keywords: bronchodilators; chronic obstructive pulmonary disease; exacerbation; inhaled corticosteroids; model; predictor.

Figures

Figure 1
Figure 1
ROC curve based on the five selected predictors (C-index =0.67), the full multivariate model (C-index =0.68) and the individual predictors: post-bronchodilator FEV1 (C-index =0.62) and the number of COPD exacerbations during the previous year (C-index =0.62). Abbreviations: COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; ROC, receiver operating characteristic.
Figure 2
Figure 2
Risk of exacerbation in 6 months based on baseline risk score for each treatment group, with the pre-bronchodilator FEV1/FVC ratio as lung function predictor. Abbreviations: FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity.

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Source: PubMed

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