Prediction of five-year mortality after COPD diagnosis using primary care records.

Accurate prognosis information after a diagnosis of chronic obstructive pulmonary disease (COPD) would facilitate earlier and better informed decisions about the use of prevention strategies and advanced care plans. We therefore aimed to develop and validate an accurate prognosis model for incident COPD cases using only information present in general practitioner (GP) records at the point of diagnosis. Incident COPD patients between 2004-2012 over the age of 35 were studied using records from 396 general practices in England. We developed a model to predict all-cause five-year mortality at the point of COPD diagnosis, using 47,964 English patients. Our model uses age, gender, smoking status, body mass index, forced expiratory volume in 1-second (FEV1) % predicted and 16 co-morbidities (the same number as the Charlson Co-morbidity Index). The performance of our chosen model was validated in all countries of the UK (N = 48,304). Our model performed well, and performed consistently in validation data. The validation area under the curves in each country varied between 0.783-0.809 and the calibration slopes between 0.911-1.04. Our model performed better in this context than models based on the Charlson Co-morbidity Index or Cambridge Multimorbidity Score. We have developed and validated a model that outperforms general multimorbidity scores at predicting five-year mortality after COPD diagnosis. Our model includes only data routinely collected before COPD diagnosis, allowing it to be readily translated into clinical practice, and has been made available through an online risk calculator (https://skiddle.shinyapps.io/incidentcopdsurvival/).

Déclaration de conflit d'intérêts

Dr. Kiddle reports grants from Medical Research Council, during the conduct of the study; personal fees from Roche Diagnostics and DIADEM, outside the submitted work. After completing this work, but before manuscript submission Dr. Kiddle became an employee of AstraZeneca. Ms. Whittaker reports grants from GlaxoSmithKline, during the conduct of the study. Dr. Seaman has nothing to disclose. Dr. Quint reports grants from MRC, grants from The Health Foundation, grants from BLF, grants and personal fees from GSK, grants and personal fees from BI, grants and personal fees from Insmed, grants and personal fees from AZ, personal fees from Chiesi, personal fees from Teva, outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.