Predictors for mortality due to exacerbation of COPD in primary care: the EXAGGERATE clinical prediction rule derivation dataset

Research hypothesis: Past medical history, symptoms and signs in a person who suffers an acute exacerbation of COPD (AECOPD) that is treated in primary care (PC) allows for predicting if they will die in the short term. Methods: Between December 2013 and November 2014, we studied people aged 40 and over seen for AECOPD in 148 health centres in Spain. Demographic variables, past medical history and signs and symptoms of the patients were collected. A logistic regression model for mortality from any cause was derived 30 days after the last PC visit. Findings: There were 1696 AECOPD included in the analysis. Seventeen patients (1%) died during follow-up. A clinical prediction rule was derived with the exacerbations suffered in the last 12 months, age and heart rate, with an area under the curve operator characteristic of 0.792 (95% confidence interval, 0.692 - 0.891) and good calibration. This rule stratifies patients into three categories of risk and suggests to the physician a different action for each: managing low-risk patients in PC, referring high-risk patients to hospitals and taking other criteria into account for decision-making in patients with medium risk. Interpretation: It is possible to accurately estimate the risk of death due to the exacerbation of COPD without the need to use complex instruments. This rule can help GPs optimize the diagnostic and therapeutic means used in these patients.

研究假设：在基层医疗（primary care, PC）机构接受治疗的慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease, AECOPD）患者，其既往病史、症状与体征可用于预测其短期死亡风险。
方法：2013年12月至2014年11月期间，本研究纳入西班牙148家基层医疗中心因AECOPD就诊的40岁及以上患者。收集患者的人口学特征、既往病史及临床症状与体征。以末次基层医疗就诊后30天内的全因死亡作为结局指标，构建Logistic回归（logistic regression）预测模型。
结果：本研究共纳入1696例AECOPD患者。随访期间共有17例患者（占比1%）死亡。基于患者近12个月内的急性加重次数、年龄及心率构建临床预测规则，其受试者工作特征曲线下面积为0.792（95%置信区间：0.692~0.891），校准度良好。该规则将患者划分为三级风险分层，并为临床医师提供差异化处置策略：对低危患者于基层医疗机构进行管理，将高危患者转诊至医院，中危患者则需结合其他指标进行临床决策。
解读：无需借助复杂工具即可准确评估AECOPD患者的短期死亡风险。该临床预测规则可帮助全科医师（general practitioners, GPs）优化此类患者的诊疗资源配置与临床决策流程。