Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts

Milo A Puhan; Nadia N Hansel; Patricia  Sobradillo; Paul  Enright,5; Peter Lange; DeMarc  Hickson; Ana M  Menezes; Gerben ter  Riet; Ulrike  Held; Antonia  Domingo-Salvany; Zab  Mosenifar; Josep M  Antó; Karel G M  Moons; Alphons  Kessels; Judith  Garcia-Aymerich

doi:10.1136/bmjopen-2012- 002152

Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts

Milo A Puhan, Nadia N Hansel, Patricia Sobradillo, Paul Enright,5, Peter Lange, DeMarc Hickson, Ana M Menezes, Gerben ter Riet, Ulrike Held, Antonia Domingo-Salvany, Zab Mosenifar, Josep M Antó, Karel G M Moons, Alphons Kessels, Judith Garcia-Aymerich

Section of Social Medicine

59 Citations (Scopus)

Abstract

Background: Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists. Objective: To conduct a large international study to validate the ADO index that uses age, dyspnoea and FEV₁ to predict 3-year mortality and to update it in order to make prediction of mortality in COPD patients as generalisable as possible. Design: Individual subject data analysis of 10 European and American cohorts (n=13 914). Setting: Population-based, primary, secondary and tertiary care. Patients: COPD GOLD stages I-IV. Measurements: We validated the original ADO index. We then obtained an updated ADO index in half of our cohorts to improve its predictive accuracy, which in turn was validated comprehensively in the remaining cohorts using discrimination, calibration and decision curve analysis and a number of sensitivity analyses. Results: 1350 (9.7%) of all subjects with COPD (60% male, mean age 61 years, mean FEV₁ 66% predicted) had died at 3 years. The original ADO index showed high discrimination but poor calibration (p<0.001 for difference between predicted and observed risk). The updated ADO index (scores from 0 to 14) preserved excellent discrimination (area under curve 0.81, 95% CI 0.80 to 0.82) but showed much improved calibration with predicted 3-year risks from 0.7% (95% CI 0.6% to 0.9%, score of 0) to 64.5% (61.2% to 67.7%, score of 14). The ADO index showed higher net benefit in subjects at low-to-moderate risk of 3-year mortality than FEV₁ alone. Interpretation: The updated 15-point ADO index accurately predicts 3-year mortality across the COPD severity spectrum and can be used to inform patients about their prognosis, clinical trial study design or benefit harm assessment of medical interventions.

Original language	English
Journal	BMJ Open
Volume	2
Pages (from-to)	e002152
Number of pages	10
DOIs	https://doi.org/10.1136/bmjopen-2012- 002152
Publication status	Published - 2012

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Puhan, M. A., Hansel, N. N., Sobradillo, P., Enright,5, P., Lange, P., Hickson, D., Menezes, A. M., Riet, G. T., Held, U., Domingo-Salvany, A., Mosenifar, Z., Antó, J. M., Moons, K. G. M., Kessels, A., & Garcia-Aymerich, J. (2012). Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts. BMJ Open, 2, e002152. https://doi.org/10.1136/bmjopen-2012- 002152

Puhan, MA, Hansel, NN, Sobradillo, P, Enright,5, P, Lange, P, Hickson, D, Menezes, AM, Riet, GT, Held, U, Domingo-Salvany, A, Mosenifar, Z, Antó, JM, Moons, KGM, Kessels, A & Garcia-Aymerich, J 2012, 'Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts', BMJ Open, vol. 2, pp. e002152. https://doi.org/10.1136/bmjopen-2012- 002152

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title = "Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts",

abstract = "Background: Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists. Objective: To conduct a large international study to validate the ADO index that uses age, dyspnoea and FEV1 to predict 3-year mortality and to update it in order to make prediction of mortality in COPD patients as generalisable as possible. Design: Individual subject data analysis of 10 European and American cohorts (n=13 914). Setting: Population-based, primary, secondary and tertiary care. Patients: COPD GOLD stages I-IV. Measurements: We validated the original ADO index. We then obtained an updated ADO index in half of our cohorts to improve its predictive accuracy, which in turn was validated comprehensively in the remaining cohorts using discrimination, calibration and decision curve analysis and a number of sensitivity analyses. Results: 1350 (9.7%) of all subjects with COPD (60% male, mean age 61 years, mean FEV1 66% predicted) had died at 3 years. The original ADO index showed high discrimination but poor calibration (p<0.001 for difference between predicted and observed risk). The updated ADO index (scores from 0 to 14) preserved excellent discrimination (area under curve 0.81, 95% CI 0.80 to 0.82) but showed much improved calibration with predicted 3-year risks from 0.7% (95% CI 0.6% to 0.9%, score of 0) to 64.5% (61.2% to 67.7%, score of 14). The ADO index showed higher net benefit in subjects at low-to-moderate risk of 3-year mortality than FEV1 alone. Interpretation: The updated 15-point ADO index accurately predicts 3-year mortality across the COPD severity spectrum and can be used to inform patients about their prognosis, clinical trial study design or benefit harm assessment of medical interventions.",

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year = "2012",

doi = "10.1136/bmjopen-2012- 002152",

language = "English",

volume = "2",

pages = "e002152",

journal = "BMJ Open",

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T1 - Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts

AU - Puhan, Milo A

AU - Hansel, Nadia N

AU - Sobradillo, Patricia

AU - Enright,5, Paul

AU - Lange, Peter

AU - Hickson, DeMarc

AU - Menezes, Ana M

AU - Riet, Gerben ter

AU - Held, Ulrike

AU - Domingo-Salvany, Antonia

AU - Mosenifar, Zab

AU - Antó, Josep M

AU - Moons, Karel G M

AU - Kessels, Alphons

AU - Garcia-Aymerich, Judith

PY - 2012

Y1 - 2012

N2 - Background: Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists. Objective: To conduct a large international study to validate the ADO index that uses age, dyspnoea and FEV1 to predict 3-year mortality and to update it in order to make prediction of mortality in COPD patients as generalisable as possible. Design: Individual subject data analysis of 10 European and American cohorts (n=13 914). Setting: Population-based, primary, secondary and tertiary care. Patients: COPD GOLD stages I-IV. Measurements: We validated the original ADO index. We then obtained an updated ADO index in half of our cohorts to improve its predictive accuracy, which in turn was validated comprehensively in the remaining cohorts using discrimination, calibration and decision curve analysis and a number of sensitivity analyses. Results: 1350 (9.7%) of all subjects with COPD (60% male, mean age 61 years, mean FEV1 66% predicted) had died at 3 years. The original ADO index showed high discrimination but poor calibration (p<0.001 for difference between predicted and observed risk). The updated ADO index (scores from 0 to 14) preserved excellent discrimination (area under curve 0.81, 95% CI 0.80 to 0.82) but showed much improved calibration with predicted 3-year risks from 0.7% (95% CI 0.6% to 0.9%, score of 0) to 64.5% (61.2% to 67.7%, score of 14). The ADO index showed higher net benefit in subjects at low-to-moderate risk of 3-year mortality than FEV1 alone. Interpretation: The updated 15-point ADO index accurately predicts 3-year mortality across the COPD severity spectrum and can be used to inform patients about their prognosis, clinical trial study design or benefit harm assessment of medical interventions.

AB - Background: Little evidence on the validity of simple and widely applicable tools to predict mortality in patients with chronic obstructive pulmonary disease (COPD) exists. Objective: To conduct a large international study to validate the ADO index that uses age, dyspnoea and FEV1 to predict 3-year mortality and to update it in order to make prediction of mortality in COPD patients as generalisable as possible. Design: Individual subject data analysis of 10 European and American cohorts (n=13 914). Setting: Population-based, primary, secondary and tertiary care. Patients: COPD GOLD stages I-IV. Measurements: We validated the original ADO index. We then obtained an updated ADO index in half of our cohorts to improve its predictive accuracy, which in turn was validated comprehensively in the remaining cohorts using discrimination, calibration and decision curve analysis and a number of sensitivity analyses. Results: 1350 (9.7%) of all subjects with COPD (60% male, mean age 61 years, mean FEV1 66% predicted) had died at 3 years. The original ADO index showed high discrimination but poor calibration (p<0.001 for difference between predicted and observed risk). The updated ADO index (scores from 0 to 14) preserved excellent discrimination (area under curve 0.81, 95% CI 0.80 to 0.82) but showed much improved calibration with predicted 3-year risks from 0.7% (95% CI 0.6% to 0.9%, score of 0) to 64.5% (61.2% to 67.7%, score of 14). The ADO index showed higher net benefit in subjects at low-to-moderate risk of 3-year mortality than FEV1 alone. Interpretation: The updated 15-point ADO index accurately predicts 3-year mortality across the COPD severity spectrum and can be used to inform patients about their prognosis, clinical trial study design or benefit harm assessment of medical interventions.

U2 - 10.1136/bmjopen-2012- 002152

DO - 10.1136/bmjopen-2012- 002152

M3 - Journal article

SN - 2044-6055

VL - 2

SP - e002152

JO - BMJ Open

JF - BMJ Open

ER -

Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts

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