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. 2021 Mar 16:16:665-675.
doi: 10.2147/COPD.S282694. eCollection 2021.

Prediction of Mortality Using Different COPD Risk Assessments - A 12-Year Follow-Up

Åsa Athlin  1 , Maaike Giezeman  1   2 , Mikael Hasselgren  1 , Scott Montgomery  3   4   5 , Karin Lisspers  6 , Björn Ställberg  6 , Christer Janson  7 , Josefin Sundh  8
Affiliations

Prediction of Mortality Using Different COPD Risk Assessments - A 12-Year Follow-Up

Åsa Athlin et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices.

Patients and methods: A total of 490 patients diagnosed with COPD were recruited from primary and secondary care in central Sweden in 2005. The cohort was followed until 2017. Data for categorization using the different assessment systems were obtained through questionnaire data from 2005 and medical record reviews between 2000 and 2003. Kaplan-Meier survival analyses and Cox proportional hazard models were used to assess mortality risk. Receiver operating characteristic curves estimated areas under the curve (AUC) to evaluate each assessment systems´ ability to predict mortality.

Results: By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3-4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75-0.83) for all-cause mortality and 0.80 (95% CI 0.75-0.85) for respiratory mortality. The AUC values for stages 1-4, GOLD 2011, GOLD 2017 and DOSE index were 0.73, 0.66, 0.63 and 0.69, respectively, for all-cause mortality.

Conclusion: All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.

Keywords: ADO index; DOSE index; GOLD classification; chronic obstructive pulmonary disease; mortality; prediction.

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Conflict of interest statement

Dr Karin Lisspers reports personal fees from Payments for lectures and educational activities, personal fees from Advisory board, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart patient selection.
Figure 2
Figure 2
Mortality rate in each group for each assessment system. Stage refers to lung function, stage 1-FEV1% pred ≥80, stage 2-FEV1% pred 50–79, stage 3-FEV1% pred 30–49, stage 4-FEV1% pred <30.
Figure 3
Figure 3
Cumulative 12-year survival for different COPD assessment systems. Lung function, stage 1-FEV1% pred ≥80, stage 2-FEV1% pred 50–79, stage 3-FEV1% pred 30–49, stage 4-FEV1% pred <30.
Figure 4
Figure 4
Receiver-operator characteristics for different COPD assessment systems as predictors of all-cause mortality. Area under the curve (AUC) for each assessment system presented. Stage 1–4 refers to lung function.
Figure 5
Figure 5
Receiver-operator characteristics for different COPD assessment systems as predictors of respiratory mortality. Area under the curve (AUC) for each assessment system presented. Stage 1–4 refers to lung function.
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