Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease

BACKGROUND: External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognos...

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Autores: Guerra, Beniamino, García Aymerich, Judith, Antó i Boqué, Josep Maria, Puhan, Milo A., Crystal structure of cold-aminopeptidase from Colwellia psychrerythraea (3CIA) collaborators
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/34333
Acceso en línea:http://hdl.handle.net/10230/34333
http://dx.doi.org/10.1186/s12916-018-1013-y
Access Level:acceso abierto
Palabra clave:COPD
Large-scale external validation
Network meta-analysis
Performance comparison
Prognostic scores
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spelling Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary diseaseGuerra, BeniaminoGarcía Aymerich, JudithAntó i Boqué, Josep MariaPuhan, Milo A.Crystal structure of cold-aminopeptidase from Colwellia psychrerythraea (3CIA) collaboratorsCOPDLarge-scale external validationNetwork meta-analysisPerformance comparisonPrognostic scoresBACKGROUND: External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores for 3-year all-cause mortality in mostly multimorbid patients with COPD. METHODS: We relied on 24 cohort studies of the COPD Cohorts Collaborative International Assessment consortium, corresponding to primary, secondary, and tertiary care in Europe, the Americas, and Japan. These studies include globally 15,762 patients with COPD (1871 deaths and 42,203 person years of follow-up). We used network meta-analysis adapted to multiple score comparison (MSC), following a frequentist two-stage approach; thus, we were able to compare all scores in a single analytical framework accounting for correlations among scores within cohorts. We assessed transitivity, heterogeneity, and inconsistency and provided a performance ranking of the prognostic scores. RESULTS: Depending on data availability, between two and nine prognostic scores could be calculated for each cohort. The BODE score (body mass index, airflow obstruction, dyspnea, and exercise capacity) had a median area under the curve (AUC) of 0.679 [1st quartile-3rd quartile = 0.655-0.733] across cohorts. The ADO score (age, dyspnea, and airflow obstruction) showed the best performance for predicting mortality (difference AUCADO - AUCBODE = 0.015 [95% confidence interval (CI) = -0.002 to 0.032]; p = 0.08) followed by the updated BODE (AUCBODE updated - AUCBODE = 0.008 [95% CI = -0.005 to +0.022]; p = 0.23). The assumption of transitivity was not violated. Heterogeneity across direct comparisons was small, and we did not identify any local or global inconsistency. CONCLUSIONS: Our analyses showed best discriminatory performance for the ADO and updated BODE scores in patients with COPD. A limitation to be addressed in future studies is the extension of MSC network meta-analysis to measures of calibration. MSC network meta-analysis can be applied to prognostic scores in any medical field to identify the best scores, possibly paving the way for stratified medicine, public health, and research.BioMed Central201820182018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/34333http://dx.doi.org/10.1186/s12916-018-1013-yreponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésBMC Medicine. 2018 Mar 2;16(1):33© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10230/343332026-05-29T05:05:01Z
dc.title.none.fl_str_mv Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease
title Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease
spellingShingle Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease
Guerra, Beniamino
COPD
Large-scale external validation
Network meta-analysis
Performance comparison
Prognostic scores
title_short Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease
title_full Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease
title_fullStr Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease
title_full_unstemmed Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease
title_sort Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease
dc.creator.none.fl_str_mv Guerra, Beniamino
García Aymerich, Judith
Antó i Boqué, Josep Maria
Puhan, Milo A.
Crystal structure of cold-aminopeptidase from Colwellia psychrerythraea (3CIA) collaborators
author Guerra, Beniamino
author_facet Guerra, Beniamino
García Aymerich, Judith
Antó i Boqué, Josep Maria
Puhan, Milo A.
Crystal structure of cold-aminopeptidase from Colwellia psychrerythraea (3CIA) collaborators
author_role author
author2 García Aymerich, Judith
Antó i Boqué, Josep Maria
Puhan, Milo A.
Crystal structure of cold-aminopeptidase from Colwellia psychrerythraea (3CIA) collaborators
author2_role author
author
author
author
dc.subject.none.fl_str_mv COPD
Large-scale external validation
Network meta-analysis
Performance comparison
Prognostic scores
topic COPD
Large-scale external validation
Network meta-analysis
Performance comparison
Prognostic scores
description BACKGROUND: External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores for 3-year all-cause mortality in mostly multimorbid patients with COPD. METHODS: We relied on 24 cohort studies of the COPD Cohorts Collaborative International Assessment consortium, corresponding to primary, secondary, and tertiary care in Europe, the Americas, and Japan. These studies include globally 15,762 patients with COPD (1871 deaths and 42,203 person years of follow-up). We used network meta-analysis adapted to multiple score comparison (MSC), following a frequentist two-stage approach; thus, we were able to compare all scores in a single analytical framework accounting for correlations among scores within cohorts. We assessed transitivity, heterogeneity, and inconsistency and provided a performance ranking of the prognostic scores. RESULTS: Depending on data availability, between two and nine prognostic scores could be calculated for each cohort. The BODE score (body mass index, airflow obstruction, dyspnea, and exercise capacity) had a median area under the curve (AUC) of 0.679 [1st quartile-3rd quartile = 0.655-0.733] across cohorts. The ADO score (age, dyspnea, and airflow obstruction) showed the best performance for predicting mortality (difference AUCADO - AUCBODE = 0.015 [95% confidence interval (CI) = -0.002 to 0.032]; p = 0.08) followed by the updated BODE (AUCBODE updated - AUCBODE = 0.008 [95% CI = -0.005 to +0.022]; p = 0.23). The assumption of transitivity was not violated. Heterogeneity across direct comparisons was small, and we did not identify any local or global inconsistency. CONCLUSIONS: Our analyses showed best discriminatory performance for the ADO and updated BODE scores in patients with COPD. A limitation to be addressed in future studies is the extension of MSC network meta-analysis to measures of calibration. MSC network meta-analysis can be applied to prognostic scores in any medical field to identify the best scores, possibly paving the way for stratified medicine, public health, and research.
publishDate 2018
dc.date.none.fl_str_mv 2018
2018
2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/34333
http://dx.doi.org/10.1186/s12916-018-1013-y
url http://hdl.handle.net/10230/34333
http://dx.doi.org/10.1186/s12916-018-1013-y
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv BMC Medicine. 2018 Mar 2;16(1):33
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
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