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Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts.
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| Title | Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts. |
| Publication Type | Journal Article |
| Year of Publication | 2012 |
| Authors | Puhan, MA, Hansel, NN, Sobradillo, P, Enright, P, Lange, P, Hickson, D, Menezes, AM, Riet, Gter, Held, U, Domingo-Salvany, A, Mosenifar, Z, Antó, JM, Moons, KGM, Kessels, A, Garcia-Aymerich, J |
| Corporate/Institutional Authors | International COPD Cohorts Collaboration Working Group |
| Journal | BMJ Open |
| Volume | 2 |
| Issue | 6 |
| Date Published | 2012 |
| ISSN | 2044-6055 |
| Abstract | <p><b>BACKGROUND: </b>Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists.</p><p><b>OBJECTIVE: </b>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.</p><p><b>DESIGN: </b>Individual subject data analysis of 10 European and American cohorts (n=13 914).</p><p><b>SETTING: </b>Population-based, primary, secondary and tertiary care.</p><p><b>PATIENTS: </b>COPD GOLD stages I-IV.</p><p><b>MEASUREMENTS: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>INTERPRETATION: </b>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.</p> |
| DOI | 10.1136/bmjopen-2012-002152 |
| Alternate Journal | BMJ Open |
| PubMed ID | 23242246 |
| PubMed Central ID | PMC3533065 |
| Grant List | P30 AG024827 / AG / NIA NIH HHS / United States R01 HL075366 / HL / NHLBI NIH HHS / United States N01 HC095170 / HC / NHLBI NIH HHS / United States R01 AG015928 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States R56 AG020098 / AG / NIA NIH HHS / United States N01 HC095172 / HC / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01 HC095171 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States R01 HL080295 / HL / NHLBI NIH HHS / United States R01 AG020098 / AG / NIA NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States R01 AG027058 / AG / NIA NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01 HR046002 / HR / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States |
ePub date:
12/12