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ACCEPT 2·0: Recalibrating and externally validating the Acute COPD exacerbation prediction tool (ACCEPT).
Abdollah Safari1,2, Amin Adibi1, Don D Sin3
1Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
Eclinicalmedicine
|July 28, 2022
Summary
The enhanced ACCEPT 2.0 tool improves Chronic Obstructive Pulmonary Disease (COPD) exacerbation prediction, especially for patients without prior events. This refined model offers better risk assessment than current standards.
Area of Science:
- Pulmonary Medicine
- Clinical Epidemiology
- Predictive Modeling
Background:
- The Acute Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Prediction Tool (ACCEPT) showed high accuracy but overestimated risk in patients without recent exacerbations.
- Existing models require refinement for improved individualized COPD exacerbation risk prediction.
Purpose of the Study:
- To fine-tune the ACCEPT tool for better prediction in patients with no recent COPD exacerbations.
- To develop more parsimonious models and externally validate them in a new dataset.
Main Methods:
- Recalibration of ACCEPT using data from the ECLIPSE study with non-parametric regression splines.
- Development of reduced ACCEPT versions by removing predictors like symptom score and baseline medications.
- External validation of ACCEPT 2.0 in the TORCH study's placebo arm.
Main Results:
- ACCEPT 2.0 achieved an AUC of 0.76, outperforming exacerbation history alone (AUC 0.68).
- The model demonstrated good calibration across patients with and without prior exacerbation history.
- Reduced ACCEPT versions showed minimal impact on primary outcome prediction, indicating parsimony.
Conclusions:
- ACCEPT 2.0 provides improved and well-calibrated COPD exacerbation risk prediction compared to the current standard of care.
- The tool's enhanced performance benefits a wider range of patients, including those with no recent exacerbations.
- Further research is needed to explore the clinical utility of ACCEPT 2.0 in diverse patient subgroups.
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