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

Mostra el registre complet Registre parcial de l'ítem

• dc.contributor.author Guerra, Beniaminoca
• dc.contributor.author García Aymerich, Judithca
• dc.contributor.author Antó i Boqué, Josep Mariaca
• dc.contributor.author Puhan, Milo A.ca
• dc.contributor.author Crystal structure of cold-aminopeptidase from Colwellia psychrerythraea (3CIA) collaboratorsca
• dc.date.accessioned 2018-04-11T07:28:20Z
• dc.date.available 2018-04-11T07:28:20Z
• dc.date.issued 2018
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Guerra B, Haile SR, Lamprecht B, Ramírez AS, Martinez-Camblor P, Kaiser B et al. 3CIA collaboration. Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease. BMC Med. 2018 Mar 2;16(1):33. DOI: 10.1186/s12916-018-1013-y
• dc.identifier.doi http://dx.doi.org/10.1186/s12916-018-1013-y
• dc.identifier.issn 1741-7015
• dc.identifier.uri http://hdl.handle.net/10230/34333
• dc.language.iso eng
• dc.publisher BioMed Centralca
• dc.relation.ispartof BMC Medicine. 2018 Mar 2;16(1):33
• dc.rights © 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.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword COPD
• dc.subject.keyword Large-scale external validation
• dc.subject.keyword Network meta-analysis
• dc.subject.keyword Performance comparison
• dc.subject.keyword Prognostic scores
• dc.title Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary diseaseca
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion