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...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2018 |
| País: | España |
| Institución: | Conselleria de Salut i Consum del Govern de les Illes Balears |
| Repositorio: | Docusalut |
| Idioma: | inglés |
| OAI Identifier: | oai:docusalut.com:20.500.13003/9381 |
| Acceso en línea: | https://hdl.handle.net/20.500.13003/9381 |
| Access Level: | acceso abierto |
| Palabra clave: | Humans Prognosis Aged Male Severity of Illness Index Female Pulmonary Disease, Chronic Obstructive Cohort Studies Middle Aged Masculino Femenino Índice de Severidad de la Enfermedad Anciano Pronóstico Persona de Mediana Edad Humanos Enfermedad Pulmonar Obstructiva Crónica Estudios de Cohortes COPD Prognostic scores Large-scale external validation Performance comparison Network meta-analysis |
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Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary diseaseGuerra, BeniaminoHaile, Sarah R.Lamprecht, BerndRamirez, Ana S.Martinez-Camblor, PabloKaiser, BernhardAlfageme, InmaculadaAlmagro, PereCasanova, CiroEsteban-Gonzalez, CristobalSoler-Cataluña, Juan Joséde-Torres, Juan P.Miravitlles, MarcCelli, BartolomeMarin, Jose M.ter Riet, GerbenSobradillo, PatriciaLange, PeterGarcia-Aymerich, JudithAnto, Josep M.Turner, Alice M.Han, Meilan K.Langhammer, ArnulfLeivseth, LindaBakke, PerJohannessen, AneOga, ToruGarcía-Cosío, BorjaAncochea-Bermudez, JulioEchazarreta, AndresRoche, NicolasBurgel, Pierre-RegisSin, Don D.Soriano, Joan B.Puhan, Milo A.3CIA CollaborationHumansPrognosisAgedMaleSeverity of Illness IndexFemalePulmonary Disease, Chronic ObstructiveCohort StudiesMiddle AgedMasculinoFemeninoÍndice de Severidad de la EnfermedadAncianoPronósticoPersona de Mediana EdadHumanosEnfermedad Pulmonar Obstructiva CrónicaEstudios de CohortesCOPDPrognostic scoresLarge-scale external validationPerformance comparisonNetwork meta-analysisBackground: 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 AUC(ADO) - AUC(BODE) = 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.BMC20182018-03-0220182018-03-02research articlehttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.13003/9381reponame:Docusalutinstname:Conselleria de Salut i Consum del Govern de les Illes BalearsInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:docusalut.com:20.500.13003/93812026-06-22T12:44:07Z |
| 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 Humans Prognosis Aged Male Severity of Illness Index Female Pulmonary Disease, Chronic Obstructive Cohort Studies Middle Aged Masculino Femenino Índice de Severidad de la Enfermedad Anciano Pronóstico Persona de Mediana Edad Humanos Enfermedad Pulmonar Obstructiva Crónica Estudios de Cohortes COPD Prognostic scores Large-scale external validation Performance comparison Network meta-analysis |
| 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 Haile, Sarah R. Lamprecht, Bernd Ramirez, Ana S. Martinez-Camblor, Pablo Kaiser, Bernhard Alfageme, Inmaculada Almagro, Pere Casanova, Ciro Esteban-Gonzalez, Cristobal Soler-Cataluña, Juan José de-Torres, Juan P. Miravitlles, Marc Celli, Bartolome Marin, Jose M. ter Riet, Gerben Sobradillo, Patricia Lange, Peter Garcia-Aymerich, Judith Anto, Josep M. Turner, Alice M. Han, Meilan K. Langhammer, Arnulf Leivseth, Linda Bakke, Per Johannessen, Ane Oga, Toru García-Cosío, Borja Ancochea-Bermudez, Julio Echazarreta, Andres Roche, Nicolas Burgel, Pierre-Regis Sin, Don D. Soriano, Joan B. Puhan, Milo A. 3CIA Collaboration |
| author |
Guerra, Beniamino |
| author_facet |
Guerra, Beniamino Haile, Sarah R. Lamprecht, Bernd Ramirez, Ana S. Martinez-Camblor, Pablo Kaiser, Bernhard Alfageme, Inmaculada Almagro, Pere Casanova, Ciro Esteban-Gonzalez, Cristobal Soler-Cataluña, Juan José de-Torres, Juan P. Miravitlles, Marc Celli, Bartolome Marin, Jose M. ter Riet, Gerben Sobradillo, Patricia Lange, Peter Garcia-Aymerich, Judith Anto, Josep M. Turner, Alice M. Han, Meilan K. Langhammer, Arnulf Leivseth, Linda Bakke, Per Johannessen, Ane Oga, Toru García-Cosío, Borja Ancochea-Bermudez, Julio Echazarreta, Andres Roche, Nicolas Burgel, Pierre-Regis Sin, Don D. Soriano, Joan B. Puhan, Milo A. 3CIA Collaboration |
| author_role |
author |
| author2 |
Haile, Sarah R. Lamprecht, Bernd Ramirez, Ana S. Martinez-Camblor, Pablo Kaiser, Bernhard Alfageme, Inmaculada Almagro, Pere Casanova, Ciro Esteban-Gonzalez, Cristobal Soler-Cataluña, Juan José de-Torres, Juan P. Miravitlles, Marc Celli, Bartolome Marin, Jose M. ter Riet, Gerben Sobradillo, Patricia Lange, Peter Garcia-Aymerich, Judith Anto, Josep M. Turner, Alice M. Han, Meilan K. Langhammer, Arnulf Leivseth, Linda Bakke, Per Johannessen, Ane Oga, Toru García-Cosío, Borja Ancochea-Bermudez, Julio Echazarreta, Andres Roche, Nicolas Burgel, Pierre-Regis Sin, Don D. Soriano, Joan B. Puhan, Milo A. 3CIA Collaboration |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
|
| dc.subject.none.fl_str_mv |
Humans Prognosis Aged Male Severity of Illness Index Female Pulmonary Disease, Chronic Obstructive Cohort Studies Middle Aged Masculino Femenino Índice de Severidad de la Enfermedad Anciano Pronóstico Persona de Mediana Edad Humanos Enfermedad Pulmonar Obstructiva Crónica Estudios de Cohortes COPD Prognostic scores Large-scale external validation Performance comparison Network meta-analysis |
| topic |
Humans Prognosis Aged Male Severity of Illness Index Female Pulmonary Disease, Chronic Obstructive Cohort Studies Middle Aged Masculino Femenino Índice de Severidad de la Enfermedad Anciano Pronóstico Persona de Mediana Edad Humanos Enfermedad Pulmonar Obstructiva Crónica Estudios de Cohortes COPD Prognostic scores Large-scale external validation Performance comparison Network meta-analysis |
| 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 AUC(ADO) - AUC(BODE) = 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 2018-03-02 2018 2018-03-02 |
| dc.type.none.fl_str_mv |
research article http://purl.org/coar/resource_type/c_2df8fbb1 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/20.500.13003/9381 |
| url |
https://hdl.handle.net/20.500.13003/9381 |
| dc.language.none.fl_str_mv |
Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
| dc.rights.none.fl_str_mv |
open access http://purl.org/coar/access_right/c_abf2 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ |
| eu_rights_str_mv |
openAccess |
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application/pdf |
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BMC |
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BMC |
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reponame:Docusalut instname:Conselleria de Salut i Consum del Govern de les Illes Balears |
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Conselleria de Salut i Consum del Govern de les Illes Balears |
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Docusalut |
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15,812429 |