在以全科医疗为基础的慢性阻塞性肺疾病队列中，ADO指数作为两年死亡率的预测指标。

The ADO index as a predictor of two-year mortality in general practice-based chronic obstructive pulmonary disease cohorts.

作者信息

Abu Hussein Nebal, Ter Riet Gerben, Schoenenberger Lucia, Bridevaux Pierre-Olivier, Chhajed Prashant N, Fitting Jean-William, Geiser Thomas, Jochmann Anja, Joos Zellweger Ladina, Kohler Malcolm, Maier Sabrina, Miedinger David, Schafroth Török Salome, Scherr Andreas, Siebeling Lara, Thurnheer Robert, Tamm Michael, Puhan Milo A, Leuppi Joerg Daniel

机构信息

University Clinic of Internal Medicine, Kantonsspital Baselland, Basel, Switzerland.

出版信息

Respiration. 2014;88(3):208-14. doi: 10.1159/000363770. Epub 2014 Aug 7.

DOI:10.1159/000363770

PMID:25115178

Abstract

BACKGROUND

Existing prediction models for mortality in chronic obstructive pulmonary disease (COPD) patients have not yet been validated in primary care, which is where the majority of patients receive care.

OBJECTIVES

Our aim was to validate the ADO (age, dyspnoea, airflow obstruction) index as a predictor of 2-year mortality in 2 general practice-based COPD cohorts.

METHODS

Six hundred and forty-six patients with COPD with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV were enrolled by their general practitioners and followed for 2 years. The ADO regression equation was used to predict a 2-year risk of all-cause mortality in each patient and this risk was compared with the observed 2-year mortality. Discrimination and calibration were assessed as well as the strength of association between the 15-point ADO score and the observed 2-year all-cause mortality.

RESULTS

Fifty-two (8.1%) patients died during the 2-year follow-up period. Discrimination with the ADO index was excellent with an area under the curve of 0.78 [95% confidence interval (CI) 0.71-0.84]. Overall, the predicted and observed risks matched well and visual inspection revealed no important differences between them across 10 risk classes (p = 0.68). The odds ratio for death per point increase according to the ADO index was 1.50 (95% CI 1.31-1.71).

CONCLUSIONS

The ADO index showed excellent prediction properties in an out-of-population validation carried out in COPD patients from primary care settings.

摘要

背景

慢性阻塞性肺疾病（COPD）患者现有死亡率预测模型尚未在大多数患者接受治疗的初级保健机构中得到验证。

目的

我们的目的是在两个基于全科医疗的COPD队列中验证ADO（年龄、呼吸困难、气流受限）指数作为2年死亡率预测指标的有效性。

方法

646例GOLD（慢性阻塞性肺疾病全球倡议组织）I-IV期COPD患者由其全科医生纳入研究并随访2年。使用ADO回归方程预测每位患者的2年全因死亡风险，并将此风险与观察到的2年死亡率进行比较。评估了辨别力和校准情况，以及15分ADO评分与观察到的2年全因死亡率之间的关联强度。

结果

在2年随访期内，52例（8.1%）患者死亡。ADO指数的辨别力极佳，曲线下面积为0.78[95%置信区间（CI）0.71-0.84]。总体而言，预测风险与观察到的风险匹配良好，直观检查显示在10个风险类别中两者之间无显著差异（p = 0.68）。根据ADO指数，每增加1分死亡的比值比为1.50（95%CI 1.31-1.71）。