{
  "abstract": "Background Acute exacerbations (AEs) drive disease progression and healthcare burden in chronic obstructive pulmonary disease (COPD). Although prior AE history is the strongest predictor of future events, it cannot guide risk assessment in AE-naïve patients, highlighting the need for new prediction tools.Method In this retrospective multicentre cohort study, we enrolled training and validation cohorts from five hospitals. Baseline demographics, symptom scores, spirometry, blood eosinophils and comorbidities were extracted from electronic records. Multivariable logistic regression was used to identify predictors and convert into score-based models.Result The training and validation cohorts included 310 and 86 AE-naïve patients with COPD, respectively. Independent predictors of 1-year AEs included coexisting asthma, modified Medical Research Council score ≥2, blood eosinophils ≥2%, per cent predicted forced expiratory volume in 1 s <50% and cardiovascular comorbidities (ie, heart failure and ischaemic cerebrovascular events). Three models were developed with areas under receiver operating characteristic curves of 0.727 to 0.750 and 0.717 to 0.728 in the training and validation cohorts, respectively. At the optimal cutoffs, the sensitivity ranged from 76.7% to 88.2% and specificity from 42.0% to 65.7%. Risk stratification separated patients into low-risk, intermediate-risk and high-risk groups in validation cohort, with increasing AE rates (0.10, 0.43 and 0.86 events/year, respectively; P for trend=0.0047).Conclusion By incorporating baseline AE history, the externally validated, score-based prediction models provide a practical tool to estimate 1-year AE risk in patients with COPD.",
  "authors": [
    {
      "affiliations": [
        "Division of Chest Medicine, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan",
        "College of Life Science, National Chung Hsing University, Taichung, Taiwan",
        "Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan"
      ],
      "name": "Yi-Luen Shen"
    },
    {
      "affiliations": [
        "Division of Chest Medicine, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan",
        "Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan"
      ],
      "name": "Chien-Wen Huang"
    },
    {
      "affiliations": [
        "Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan",
        "School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan"
      ],
      "name": "Yao-Tung Wang"
    },
    {
      "affiliations": [
        "Division of Chest Medicine, Department of Internal Medicine, Cheng Ching General Hospital, Taichung, Taiwan"
      ],
      "name": "Chun Hui"
    },
    {
      "affiliations": [
        "Division of Chest Medicine, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan"
      ],
      "name": "Yi-An Hsieh"
    },
    {
      "affiliations": [
        "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan",
        "School of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan",
        "Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan"
      ],
      "name": "Hung-Ling Huang"
    },
    {
      "affiliations": [
        "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan",
        "School of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan",
        "Department of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan"
      ],
      "name": "Meng-Hsuan Cheng"
    },
    {
      "affiliations": [
        "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan",
        "School of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan"
      ],
      "name": "Chau-Chyun Sheu"
    },
    {
      "affiliations": [
        "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan",
        "School of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan"
      ],
      "name": "Inn-Wen Chong"
    },
    {
      "affiliations": [
        "School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan",
        "Division of Pulmonary Immunology & Infectious Diseases, Department of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan",
        "Department of Post–Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan"
      ],
      "name": "Wei-Chang Huang"
    }
  ],
  "title": "Development and validation of a risk stratification tool for predicting COPD exacerbations in patients without prior exacerbation history",
  "uid": "d4c3af78-c0c8-555f-9235-4840b3c8be97"
}