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. 2020 Oct;7(4):346-361.
doi: 10.15326/jcopdf.7.4.2020.0146.

A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study

Matthew Strand  1 , Erin Austin  2 , Matthew Moll  3 , Katherine A Pratte  1 , Elizabeth A Regan  1 , Lystra P Hayden  3 , Surya P Bhatt  4 , Aladin M Boriek  5 , Richard Casaburi  6 , Edwin K Silverman  3 , Spyridon Fortis  7 , Ingo Ruczinski  8 , Harald Koegler  9 , Harry B Rossiter  6   10 , Mariaelena Occhipinti  11 , Nicola A Hanania  5 , Hirut T Gebrekristos  12 , David A Lynch  1 , Ken M Kunisaki  13 , Kendra A Young  14 , Jessica C Sieren  7 , Margaret Ragland  14 , John E Hokanson  14 , Sharon M Lutz  15 , Barry J Make  1 , Gregory L Kinney  14 , Michael H Cho  3 , Massimo Pistolesi  11 , Dawn L DeMeo  3   15 , Frank C Sciurba  16 , Alejandro P Comellas  7 , Alejandro A Diaz  3 , Igor Barjaktarevic  17 , Russell P Bowler  1 , Richard E Kanner  18 , Stephen P Peters  19 , Victor E Ortega  19 , Mark T Dransfield  4 , James D Crapo  1
Affiliations

A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study

Matthew Strand et al. Chronic Obstr Pulm Dis. 2020 Oct.

Abstract

Background: Risk factor identification is a proven strategy in advancing treatments and preventive therapy for many chronic conditions. Quantifying the impact of those risk factors on health outcomes can consolidate and focus efforts on individuals with specific high-risk profiles. Using multiple risk factors and longitudinal outcomes in 2 independent cohorts, we developed and validated a risk score model to predict mortality in current and former cigarette smokers.

Methods: We obtained extensive data on current and former smokers from the COPD Genetic Epidemiology (COPDGene®) study at enrollment. Based on physician input and model goodness-of-fit measures, a subset of variables was selected to fit final Weibull survival models separately for men and women. Coefficients and predictors were translated into a point system, allowing for easy computation of mortality risk scores and probabilities. We then used the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) cohort for external validation of our model.

Results: Of 9867 COPDGene participants with standard baseline data, 17.6% died over 10 years of follow-up, and 9074 of these participants had the full set of baseline predictors (standard plus 6-minute walk distance and computed tomography variables) available for full model fits. The average age of participants in the cohort was 60 for both men and women, and the average predicted 10-year mortality risk was 18% for women and 25% for men. Model time-integrated area under the receiver operating characteristic curve statistics demonstrated good predictive model accuracy (0.797 average), validated in the external cohort (0.756 average). Risk of mortality was impacted most by 6-minute walk distance, forced expiratory volume in 1 second and age, for both men and women.

Conclusions: Current and former smokers exhibited a wide range of mortality risk over a 10- year period. Our models can identify higher risk individuals who can be targeted for interventions to reduce risk of mortality, for participants with or without chronic obstructive pulmonary disease (COPD) using current Global initiative for obstructive Lung Disease (GOLD) criteria.

Keywords: COPD Genetic Epidemiology study; COPDGene; PRISm; copd; preserved ratio-impaired spirometry; risk score; spirometry.

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Conflict of interest statement

The COPDGene® study is funded by National Heart, Lung, and Blood Institute grants U01 HL089897 and U01 HL089856. The COPDGene® study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee comprised of AstraZeneca, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Novartis, Pfizer, Siemens, and Sunovion. While some individual authors of this manuscript were employed by one of the listed funders at the time the work of this study was conducted, these employment relationships did not constitute undue influence by funders. These funders have had no official role in the collection, management, analysis and interpretation of the data or design and conduct of the study. All authors have completed a Conflict of Interest form, disclosing any real or apparent financial relationships including receiving royalties, honoraria or fees for consulting, lectures, speakers’ bureaus, continuing education, medical advisory boards or expert testimony; receipt of grants; travel reimbursement; direct employment compensation. These disclosure forms have been filed with the Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation Editorial Office and are available for review, upon request, at jcopdf@copdfoundation.org.

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