Integrated Pulmonary Severity Score (IPSS) for COPD: A Psycho-Respiratory Risk Index Supported by Explainable Machine
Iulian-Laurențiu Buican1,2, Alina-Catalina Buican-Chirea1,3, Dumitru Radulescu4
1U.M.F. Doctoral School Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Diagnostics (Basel, Switzerland)
|February 27, 2026
Summary
This study developed the Integrated Pulmonary Severity Score (IPSS) to assess chronic obstructive pulmonary disease (COPD) severity by combining respiratory function, symptoms, and mental health. The IPSS aids in identifying a distinct psycho-respiratory phenotype for better patient risk stratification.
Area of Science:
- Pulmonary Medicine and Psychiatry
- Biostatistics and Health Informatics
Background:
- Forced expiratory volume in one second (FEV1) in chronic obstructive pulmonary disease (COPD) incompletely explains symptom variability and prognosis.
- Anxiety and depression are prevalent in COPD but are seldom integrated into composite severity indices.
Purpose of the Study:
- To develop and internally validate an Integrated Pulmonary Severity Score (IPSS).
- To combine respiratory function, symptom burden, and affective status into a single score for COPD assessment.
Main Methods:
- Prospective observational study of 390 COPD patients across two Romanian tertiary centers.
- Utilized spirometry (FEV1% predicted), mMRC dyspnea scale, COPD Assessment Test (CAT), Hospital Anxiety and Depression Scale (HADS), and cognitive tests (MoCA, MMSE).
- Developed PulmoScore (CAT, mMRC, ventilatory deficit) and extended it to IPSS using a HADS-based psychiatric multiplier; employed spectral clustering, logistic regression, MLP, and LIME for phenotyping and validation.
Main Results:
- Identified two phenotypes: psycho-respiratory and predominantly respiratory, with the former showing lower FEV1%, higher symptom burden (CAT, mMRC), and increased anxiety/depression.
- The IPSS effectively captured the psycho-respiratory phenotype, with logistic regression and MLP achieving 0.89 accuracy and 0.95 AUC.
- IPSS values stratified patients into four groups, correlating with increased respiratory and affective burden.
Conclusions:
- The IPSS integrates respiratory and affective dimensions, offering improved severity assessment beyond spirometry alone in COPD.
- The score aids in identifying a clinically relevant psycho-respiratory phenotype, suggesting potential for enhanced risk stratification.
- IPSS is computable from routine measures and compatible with explainable AI, warranting further external and longitudinal validation.
Keywords:
Integrated Pulmonary Severity Score (IPSS)anxietychronic obstructive pulmonary disease (COPD)depressionexplainable artificial intelligenceseverity assessmentMore Related Videos
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