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Predicting COPD 1-year mortality using prognostic predictors routinely measured in primary care.

C I Bloom1, F Ricciardi2, L Smeeth3

  • 1National Heart Lung Institute, Imperial College London, Emmanuel Kaye Building, 1b Manresa Road, London, SW3 6LR, UK. chloe.bloom06@imperial.ac.uk.

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Summary

A new risk score, BARC, accurately predicts 1-year mortality in chronic obstructive pulmonary disease (COPD) patients. This tool uses routine data to identify individuals who may benefit from palliative care, improving end-of-life support.

Keywords:
COPDMortalityPalliative carePredictionRisk score

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Area of Science:

  • Pulmonary Medicine
  • Health Services Research
  • Biostatistics

Background:

  • Chronic obstructive pulmonary disease (COPD) significantly contributes to mortality and reduces patient quality of life.
  • Palliative care is recommended for advanced COPD patients in their last year of life, but its uptake is limited.
  • Difficulty in accurately predicting 1-year mortality is a key barrier to timely palliative care initiation in COPD.

Purpose of the Study:

  • To develop and validate a novel risk prediction model for 1-year mortality in patients with chronic obstructive pulmonary disease (COPD).
  • To assess the performance of the new model against existing mortality prediction tools.
  • To identify COPD patients in primary care who could benefit from palliative care interventions.

Main Methods:

  • Utilized two UK primary care COPD cohorts from electronic healthcare records (Clinical Practice Research Datalink).
  • Developed a Cox regression model (BARC index) using training data, incorporating factors like BMI, blood results, age, respiratory variables, and comorbidities.
  • Validated the BARC index's predictive performance (calibration and discrimination) in a separate test set and an external dataset, comparing it with BODEx, DOSE, and ADO scores.

Main Results:

  • The BARC index demonstrated acceptable predictive performance in both the test set (C-index=0.79) and external dataset (C-index=0.67).
  • It accurately predicted the probability of death within 1 year, with observed and expected probabilities closely aligned across risk quartiles.
  • BARC significantly outperformed existing scores (BODEx, DOSE, ADO) in predicting 1-year mortality, particularly when specialist respiratory variables were unavailable.

Conclusions:

  • The BARC index is a superior tool for predicting 1-year mortality in COPD patients compared to current methods.
  • Its reliance on routinely collected, non-specialist data makes it highly applicable in primary care settings.
  • The BARC index can facilitate the identification of COPD patients eligible for and likely to benefit from palliative care.