Hasselt University, Hasselt, Belgium, and University of Antwerp, Antwerp, Belgium.
University Medical Center Utrecht, Utrecht, the Netherlands.
Br J Gen Pract. 2018 May;68(670):e342-e350. doi: 10.3399/bjgp18X695789. Epub 2018 Apr 9.
Accurate prediction of the course of an acute cough episode could curb antibiotic overprescribing, but is still a major challenge in primary care.
The authors set out to develop a new prediction rule for poor outcome (re-consultation with new or worsened symptoms, or hospital admission) in adults presenting to primary care with acute cough.
Data were collected from 2604 adults presenting to primary care with acute cough or symptoms suggestive of lower respiratory tract infection (LRTI) within the Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe (GRACE; www.grace-lrti.org) Network of Excellence.
Important signs and symptoms for the new prediction rule were found by combining random forest and logistic regression modelling. Performance to predict poor outcome in acute cough patients was compared with that of existing prediction rules, using the models' area under the receiver operator characteristic curve (AUC), and any improvement obtained by including additional test results (C-reactive protein [CRP], blood urea nitrogen [BUN], chest radiography, or aetiology) was evaluated using the same methodology.
The new prediction rule, included the baseline Risk of poor outcome, Interference with daily activities, number of years stopped Smoking (> or <45 years), severity of Sputum, presence of Crackles, and diastolic blood pressure (> or <85 mmHg) (RISSC85). Though performance of RISSC85 was moderate (sensitivity 62%, specificity 59%, positive predictive value 27%, negative predictive value 86%, AUC 0.63, 95% confidence interval [CI] = 0.61 to 0.67), it outperformed all existing prediction rules used today (highest AUC 0.53, 95% CI = 0.51 to 0.56), and could not be significantly improved by including additional test results (highest AUC 0.64, 95% CI = 0.62 to 0.68).
The new prediction rule outperforms all existing alternatives in predicting poor outcome in adult patients presenting to primary care with acute cough and could not be improved by including additional test results.
准确预测急性咳嗽发作的病程可能有助于减少抗生素的过度使用，但这仍然是初级保健中的一个主要挑战。
作者旨在为因急性咳嗽就诊于初级保健的成年人开发一种新的不良结局（新症状或症状恶化、再次就诊，或住院）预测规则。
数据来自 2604 名因急性咳嗽或疑似下呼吸道感染（LRTI）就诊于初级保健的成年人，这些数据来自欧洲社区获得性 LRTI 中对抗抗生素耐药性的基因组学卓越网络（GRACE；www.grace-lrti.org）。
通过组合随机森林和逻辑回归模型找到了新预测规则的重要体征和症状。使用模型的受试者工作特征曲线下面积（AUC）比较了该模型在预测急性咳嗽患者不良结局方面的表现，并使用相同的方法评估了通过纳入其他检测结果（C 反应蛋白[CRP]、血尿素氮[BUN]、胸部 X 线或病因）获得的任何改善。
新的预测规则包括基线不良结局风险、日常生活干扰、停止吸烟年数（>45 岁或<45 岁）、痰液严重程度、湿啰音存在和舒张压（>85mmHg 或<85mmHg）（RISSC85）。尽管 RISSC85 的性能中等（敏感性 62%、特异性 59%、阳性预测值 27%、阴性预测值 86%、AUC 0.63、95%置信区间[CI]为 0.61 至 0.67），但它优于目前使用的所有现有预测规则（最高 AUC 0.53，95%CI=0.51 至 0.56），且不能通过纳入其他检测结果显著改善（最高 AUC 0.64，95%CI=0.62 至 0.68）。
新的预测规则在预测因急性咳嗽就诊于初级保健的成年患者的不良结局方面优于所有现有替代方案，且不能通过纳入其他检测结果来改善。
