Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
Department of Respiratory and Sleep Medicine, The Austin Hospital, Melbourne, VIC, Australia.
BMJ Open Respir Res. 2021 Dec;8(1). doi: 10.1136/bmjresp-2021-001138.
Classifying individuals at high chronic obstructive pulmonary disease (COPD)-risk creates opportunities for early COPD detection and active intervention.
To develop and validate a statistical model to predict 10-year probabilities of COPD defined by post-bronchodilator airflow obstruction (post-BD-AO; forced expiratory volume in 1 s/forced vital capacity<5th percentile).
General Caucasian populations from Australia and Europe, 10 and 27 centres, respectively.
For the development cohort, questionnaire data on respiratory symptoms, smoking, asthma, occupation and participant sex were from the Tasmanian Longitudinal Health Study (TAHS) participants at age 41-45 years (n=5729) who did not have self-reported COPD/emphysema at baseline but had post-BD spirometry and smoking status at age 51-55 years (n=2407). The validation cohort comprised participants from the European Community Respiratory Health Survey (ECRHS) II and III (n=5970), restricted to those of age 40-49 and 50-59 with complete questionnaire and spirometry/smoking data, respectively (n=1407).
Risk-prediction models were developed using randomForest then externally validated.
Area under the receiver operating characteristic curve (AUC) of the final model was 80.8% (95% CI 80.0% to 81.6%), sensitivity 80.3% (77.7% to 82.9%), specificity 69.1% (68.7% to 69.5%), positive predictive value (PPV) 11.1% (10.3% to 11.9%) and negative predictive value (NPV) 98.7% (98.5% to 98.9%). The external validation was fair (AUC 75.6%), with the PPV increasing to 17.9% and NPV still 97.5% for adults aged 40-49 years with ≥1 respiratory symptom. To illustrate the model output using hypothetical case scenarios, a 43-year-old female unskilled worker who smoked 20 cigarettes/day for 30 years had a 27% predicted probability for post-BD-AO at age 53 if she continued to smoke. The predicted risk was 42% if she had coexistent active asthma, but only 4.5% if she had quit after age 43.
This novel and validated risk-prediction model could identify adults aged in their 40s at high 10-year COPD-risk in the general population with potential to facilitate active monitoring/intervention in predicted 'COPD cases' at a much earlier age.
对患有慢性阻塞性肺疾病（COPD）高危人群进行分类，为早期 COPD 检测和积极干预提供了机会。
开发和验证一种预测使用支气管扩张剂后气流受限（post-BD-AO；1 秒用力呼气容积/用力肺活量<第 5 百分位数）的 10 年 COPD 概率的统计模型。
澳大利亚和欧洲的普通白种人群，分别有 10 个和 27 个中心。
在开发队列中，调查问卷数据包括呼吸症状、吸烟、哮喘、职业和参与者性别，来自塔斯马尼亚纵向健康研究（TAHS）的参与者，年龄在 41-45 岁，基线时无自我报告的 COPD/肺气肿，但在 51-55 岁时进行了 post-BD 肺功能检查和吸烟情况（n=5729）。验证队列包括来自欧洲社区呼吸健康调查（ECRHS）II 和 III 的参与者（n=5970），限定为年龄在 40-49 岁和 50-59 岁的参与者，分别具有完整的问卷和肺功能/吸烟数据（n=1407）。
使用随机森林（randomForest）开发风险预测模型，然后进行外部验证。
最终模型的受试者工作特征曲线下面积（AUC）为 80.8%（95%CI 80.0%至 81.6%），灵敏度为 80.3%（77.7%至 82.9%），特异性为 69.1%（68.7%至 69.5%），阳性预测值（PPV）为 11.1%（10.3%至 11.9%），阴性预测值（NPV）为 98.7%（98.5%至 98.9%）。外部验证结果尚可（AUC 为 75.6%），40-49 岁有≥1 个呼吸系统症状的成年人的阳性预测值增加到 17.9%，阴性预测值仍为 97.5%。为了通过假设病例场景说明模型输出，一名 43 岁的女性非熟练工人，每天吸烟 20 支，吸烟 30 年，如果继续吸烟，那么她在 53 岁时 post-BD-AO 的预测概率为 27%。如果她同时患有活动性哮喘，那么预测风险为 42%，但如果她在 43 岁后戒烟，那么预测风险仅为 4.5%。
这种新颖且经过验证的风险预测模型可以识别出 40 多岁的成年人，他们在普通人群中具有较高的 10 年 COPD 风险，有可能更早地对预测的“COPD 病例”进行积极监测/干预。
