University of California San Francisco, 505 Parnassus Ave, M-1097, San Francisco, CA 94143-0111, USA.
Chest. 2010 Apr;137(4):846-51. doi: 10.1378/chest.09-1855. Epub 2009 Dec 29.
A comprehensive survey-based COPD severity score has usefulness for epidemiologic and health outcomes research. We previously developed and validated the survey-based COPD Severity Score without using lung function or other physiologic measurements. In this study, we aimed to further validate the severity score in a different COPD cohort and using a combination of patient-reported and objective physiologic measurements.
Using data from the Function, Living, Outcomes, and Work cohort study of COPD, we evaluated the concurrent and predictive validity of the COPD Severity Score among 1,202 subjects. The survey instrument is a 35-point score based on symptoms, medication and oxygen use, and prior hospitalization or intubation for COPD. Subjects were systemically assessed using structured telephone survey, spirometry, and 6-min walk testing.
We found evidence to support concurrent validity of the score. Higher COPD Severity Score values were associated with poorer FEV(1) (r = -0.38), FEV(1)% predicted (r = -0.40), Body mass, Obstruction, Dyspnea, Exercise Index (r = 0.57), and distance walked in 6 min (r = -0.43) (P < .0001 in all cases). Greater COPD severity was also related to poorer generic physical health status (r = -0.49) and disease-specific health-related quality of life (r = 0.57) (P < .0001). The score also demonstrated predictive validity. It was also associated with a greater prospective risk of acute exacerbation of COPD defined as ED visits (hazard ratio [HR], 1.31; 95% CI, 1.24-1.39), hospitalizations (HR, 1.59; 95% CI, 1.44-1.75), and either measure of hospital-based care for COPD (HR, 1.34; 95% CI, 1.26-1.41) (P < .0001 in all cases).
The COPD Severity Score is a valid survey-based measure of disease-specific severity, both in terms of concurrent and predictive validity. The score is a psychometrically sound instrument for use in epidemiologic and outcomes research in COPD.
基于全面调查的 COPD 严重程度评分对流行病学和健康结果研究具有一定的作用。我们之前已经开发并验证了基于调查的 COPD 严重程度评分，该评分不使用肺功能或其他生理测量值。在这项研究中，我们旨在使用患者报告和客观生理测量的组合，在另一个 COPD 队列中进一步验证该严重程度评分。
我们使用 COPD 功能、生活、结果和工作队列研究的数据，对 1202 名患者的 COPD 严重程度评分的同时效和预测效度进行了评估。该调查工具是一个基于症状、药物和氧气使用以及 COPD 住院或插管的 35 分评分。对患者进行系统评估，包括使用结构化电话调查、肺活量测定和 6 分钟步行测试。
我们发现有证据支持该评分的同时效性。较高的 COPD 严重程度评分与较差的 FEV1（r = -0.38）、FEV1%预测值（r = -0.40）、体重、阻塞、呼吸困难、运动指数（r = 0.57）和 6 分钟步行距离（r = -0.43）相关（所有情况下均 P <.0001）。更严重的 COPD 还与较差的一般身体健康状况（r = -0.49）和特定于疾病的健康相关生活质量（r = 0.57）相关（均 P <.0001）。该评分还具有预测效度。它还与 COPD 急性加重的更大前瞻性风险相关，定义为 ED 就诊（风险比 [HR]，1.31；95%CI，1.24-1.39）、住院（HR，1.59；95%CI，1.44-1.75）和 COPD 的任何一种基于医院的护理措施（HR，1.34；95%CI，1.26-1.41）（所有情况下均 P <.0001）。
COPD 严重程度评分是一种有效的基于调查的疾病特异性严重程度测量方法，无论是在同时效性还是预测效度方面。该评分是一种在 COPD 的流行病学和结果研究中具有良好心理测量特性的工具。
