{
  "abstract": "Introduction Efficient preventive management of acute exacerbation of chronic obstructive pulmonary disease (COPD) is predicated on accurate risk stratification. We compared the performance of exacerbation history (current standard of care) versus a revised version of a multivariable risk scoring tool (Acute COPD Exacerbation Prediction Tool (ACCEPT)) using primary-care UK data.Methods We used validated case definitions to identify diagnosed patients with COPD ≥40 years old from the UK Clinical Practice Research Datalink Aurum (2004–2020). For each patient, a single annual COPD visit was randomly selected as the index date. The outcome was the occurrence of ≥1 moderate/severe exacerbation(s) within a year of the index date. We conducted time-to-event analyses of the latest version of ACCEPT (ACCEPT 2.0) and developed a recalibrated version (ACCEPT 3.0-UK). Model performance was evaluated using discrimination (time-dependent area under the receiver operating characteristic curve (AUC)), calibration and net benefit.Results The final cohort included 158 384 patients (55.0% male; mean age 71.5 years). ACCEPT 2.0 achieved an AUC of 0.77 for predicting moderate/severe exacerbations, outperforming both any and frequent exacerbator categories (AUC: 0.69 and 0.67, respectively). However, it overpredicted exacerbation events (observed-to-expected (O/E) ratio: 0.81 (95% CI 0.80 to 0.81)). Recalibration resolved this overprediction, yielding O/E ratio of 1.00 (95% CI 0.99 to 1.00), while maintaining discrimination (AUC: 0.77). ACCEPT 3.0-UK was net beneficial and superior to exacerbation history across a wide range of risk thresholds.Conclusion ACCEPT 3.0-UK has substantially higher performance than exacerbation history, quantifies predicted risks for shared decision-making and is likely to confer clinical utility for risk stratification in primary care.",
  "authors": [
    {
      "affiliations": [
        "The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada"
      ],
      "name": "Jeenat Mehareen"
    },
    {
      "affiliations": [
        "Saw Swee Hock School of Public Health, National University of Singapore, Singapore"
      ],
      "name": "Laura Huey Mien Lim"
    },
    {
      "affiliations": [
        "The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada"
      ],
      "name": "Amin Adibi"
    },
    {
      "affiliations": [
        "The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada",
        "BCCDC, Vancouver, British Columbia, Canada"
      ],
      "name": "Joseph Emil Amegadzie"
    },
    {
      "affiliations": [
        "Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Yuan Xia"
    },
    {
      "affiliations": [
        "The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada",
        "Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada"
      ],
      "name": "Mary A De Vera"
    },
    {
      "affiliations": [
        "Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada",
        "Centre for Health Policy, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Michael R Law"
    },
    {
      "affiliations": [
        "The University of British Columbia Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada"
      ],
      "name": "Don D Sin"
    },
    {
      "affiliations": [
        "Center for Lung Analytics and Imaging Research, and Division of Pulmonary, Allergy and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA"
      ],
      "name": "Surya P Bhatt"
    },
    {
      "affiliations": [
        "NHLI, Imperial College London, London, UK"
      ],
      "name": "Jennifer K Quint"
    },
    {
      "affiliations": [
        "The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada"
      ],
      "name": "Mohsen Sadatsafavi"
    }
  ],
  "title": "Performance of multivariable risk prediction algorithms in predicting COPD exacerbations: a population-based study",
  "uid": "ca5bb204-8a1b-5a48-bf4c-5ac91229b564"
}