Development and Internal Validation of a Prediction Model Incorporating Respiratory Muscle Function for CAT Score
Muye Niu1, Changye Wu2, Shaoting Geng3
1Hebei Sport University, Shijiazhuang, Hebei, China.
Objective:
The objectives are to investigate the association between respiratory muscle function and CAT score deterioration in stable chronic obstructive pulmonary disease (COPD) and to develop an internally validated prediction model.
Methods:
This single-center retrospective cohort study included 203 patients with stable COPD. Clinically significant CAT score deterioration was defined as an increase of ≥ 2 points from baseline within 12 months. Predictors were selected using LASSO Cox regression and incorporated into a multivariable Cox model. Model performance and the incremental value of maximal inspiratory pressure (MIP) and diaphragm thickening fraction (DTF) were evaluated.
Results:
During follow-up, 62 patients (30.5%) experienced CAT score deterioration. Higher FEV1% predicted (HR = 0.973, 95% CI: 0.956-0.990), MIP (HR = 0.974, 95% CI: 0.957-0.992), and DTF (HR = 0.908, 95% CI: 0.853-0.967) were associated with a lower risk, whereas higher baseline CAT scores and more frequent prior exacerbations were associated with a higher risk. The model showed an apparent 12-month AUC of 0.873 (95% CI: 0.822-0.924), with an optimism-corrected AUC of 0.859. Adding MIP and DTF increased the 12-month AUC from 0.801 to 0.873 (ΔAUC = 0.072), with an NRI of 0.527 and an IDI of 0.058. Sensitivity analyses yielded consistent results.
Conclusions:
Lower MIP and DTF were independently associated with a higher risk of CAT score deterioration in stable COPD. Incorporating these parameters provided incremental predictive information beyond conventional clinical predictors. External validation is required.
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