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Prediction of five-year mortality after COPD diagnosis using primary care records.

Accepted version
Peer-reviewed

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Authors

Whittaker, Hannah R 
Seaman, Shaun R 
Quint, Jennifer K 

Abstract

Accurate prognosis information after a diagnosis of chronic obstructive pulmonary disease (COPD) would facilitate earlier and better informed decisions about the use of prevention strategies and advanced care plans. We therefore aimed to develop and validate an accurate prognosis model for incident COPD cases using only information present in general practitioner (GP) records at the point of diagnosis. Incident COPD patients between 2004-2012 over the age of 35 were studied using records from 396 general practices in England. We developed a model to predict all-cause five-year mortality at the point of COPD diagnosis, using 47,964 English patients. Our model uses age, gender, smoking status, body mass index, forced expiratory volume in 1-second (FEV1) % predicted and 16 co-morbidities (the same number as the Charlson Co-morbidity Index). The performance of our chosen model was validated in all countries of the UK (N = 48,304). Our model performed well, and performed consistently in validation data. The validation area under the curves in each country varied between 0.783-0.809 and the calibration slopes between 0.911-1.04. Our model performed better in this context than models based on the Charlson Co-morbidity Index or Cambridge Multimorbidity Score. We have developed and validated a model that outperforms general multimorbidity scores at predicting five-year mortality after COPD diagnosis. Our model includes only data routinely collected before COPD diagnosis, allowing it to be readily translated into clinical practice, and has been made available through an online risk calculator (https://skiddle.shinyapps.io/incidentcopdsurvival/).

Description

Keywords

Adult, Age Factors, Aged, England, Female, Forced Expiratory Volume, Humans, Middle Aged, Primary Health Care, Prognosis, Pulmonary Disease, Chronic Obstructive, Risk Assessment, Risk Factors, Severity of Illness Index, Survival Rate

Journal Title

PLoS One

Conference Name

Journal ISSN

1932-6203
1932-6203

Volume Title

15

Publisher

Public Library of Science (PLoS)

Rights

All rights reserved
Sponsorship
Medical Research Council (MR/P021573/1)