Current prediction tools underestimate exacerbation risk of severe COPD patients

Both the BLISS and the Bertens’ prognostics scores were not sufficiently accurate to assess risk of exacerbation in the COPD cohort of the ECLIPSE trial [1].

“Accurate prediction is important because weighing the individual risk estimates against the benefit and harm of treatment can help to assist clinical decision-making and guide resource allocation,” explained PhD student Spencer Keene (Maastricht University, the Netherlands). Various prediction tools for COPD exacerbations have been developed, but only the Birmingham Lung Improvement Studies (BLISS) prognostic score (including 6 variables: age, CAT score, respiratory admissions previous 12m, BMI, diabetes, and FEV₁% predicted) and the Bertens’ score (including 4 variables: exacerbations in the previous year, pack years of smoking, level of obstruction, and history of vascular disease) have methodological rigour and practicality [2,3]. They have been tested in primary care patients but not in more severe COPD patients with at least 1 moderate-to-severe exacerbation within 2-years. Thus, Mr Keene and colleagues tested these scores in the COPD cohort of the observational, multicentre ECLIPSE study.

The cohort included 1,749 COPD participants (mean age 63 years; 35% female), of whom 1,214 (69%) had >1 exacerbation within 2-years. The BLISS score showed good discrimination and accurately predicted severe exacerbation in the ECLIPSE COPD patients. It performed better than the Bertens’ score. However, due to systematic under-prediction of risk, neither score should be used to predict moderate-to-severe exacerbations.

 

1. 
   
   1. Keene S. External validation of two prognostic scores predicting exacerbations in ECLIPSE COPD patients. Abstract 4192, ERS International Virtual Congress 2020, 7-9 Sept.
   2. Jordan R, et al. Eur Respir J 2019;54:Suppl.63, OA257.
   3. Bertens LC, et al. Int J Chron Obstruct Pulmon Dis 2013;8:493-499.

Posted on 29 October 2020