03535nas a2200613 4500000000100000008004100001653001100042653001100053653000900064653000900073653002200082653001600104653001700120653003000137653003000167653003000197653002000227653001700247653001400264653002100278653004200299653002600341653002000367653001600387653003200403653002200435653005600457653003000513653004300543653003100586653003200617653002400649653003400673653002900707653003600736653003900772653007300811653002800884653001900912100001500931700001400946700001200960700001500972700001600987700001601003700001701019700001501036245007001051250001501121300001001136490000701146520171701153020005102870 2015 d 10 aFemale 10 aHumans 10 aAged 10 aMale 10 aTreatment Outcome 10 aMiddle Aged 10 aRisk Factors 10 aSeverity of Illness Index 10 aPredictive Value of Tests 10 aDrug Therapy, Combination 10 aRisk Assessment 10 aTime Factors 10 aROC Curve 10 aArea Under Curve 10 aRandomized Controlled Trials as Topic 10 aMultivariate Analysis 10 aLogistic Models 10 aSex Factors 10 aProportional Hazards Models 10 aDrug Combinations 10 aAdrenergic beta-2 Receptor Agonists/therapeutic use 10 aAlbuterol/therapeutic use 10 aBronchodilator Agents/ therapeutic use 10 aBudesonide/therapeutic use 10 aDecision Support Techniques 10 aDisease Progression 10 aEthanolamines/therapeutic use 10 aForced Expiratory Volume 10 aGlucocorticoids/therapeutic use 10 aLung/ drug effects/physiopathology 10 aPulmonary Disease, Chronic Obstructive/complications/diagnosis/ drug 10 atherapy/physiopathology 10 aVital Capacity 1 aJenkins C. 1 aPostma D. 1 aMake B. 1 aOstlund O. 1 aPeterson S. 1 aEriksson G. 1 aCalverley P. 1 aAnzueto A. 00 aA score to predict short-term risk of COPD exacerbations (SCOPEX) a2015/02/12 a201-9 0 v10 3 a
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 beta2-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.
a1178-2005 (Electronic)
1176-9106 (Linking)