Modified and simplified clinically important deterioration: multidimensional indices of short-term disease trajectory to predict future exacerbations in patients with chronic obstructive pulmonary disease

Yi-Yang Zhao; Cong Liu; Yu-Qin Zeng; Ai-Yuan Zhou; Jia-Xi Duan; Wei Cheng; Tian Sun; Xin Li; Li-Bing Ma; Qi-Mi Liu; Ying-Qun Zhu; Ming Chen; Mei-Ling Zhou; Ping Chen

doi:10.1177/1753466620977376

Modified and simplified clinically important deterioration: multidimensional indices of short-term disease trajectory to predict future exacerbations in patients with chronic obstructive pulmonary disease

Ther Adv Respir Dis. 2020 Jan-Dec:14:1753466620977376. doi: 10.1177/1753466620977376.

Authors

Yi-Yang Zhao^{1

2

3}, Cong Liu^{1

2

3}, Yu-Qin Zeng^{1

2

3}, Ai-Yuan Zhou^{1

2

3}, Jia-Xi Duan^{1

2

3}, Wei Cheng^{1

2

3}, Tian Sun^{1

2

3}, Xin Li⁴, Li-Bing Ma⁵, Qi-Mi Liu⁶, Ying-Qun Zhu⁷, Ming Chen⁸, Mei-Ling Zhou⁹, Ping Chen^{10

11

12}

Affiliations

¹ Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
² Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China.
³ Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China.
⁴ Division 4 of Occupational Disease, Hunan Occupational Disease Prevention and Treatment Hospital, Changsha, Hunan, China.
⁵ Department of Respiratory and Critical Care medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
⁶ Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Guilin, Guilin, Guangxi, China.
⁷ Department of Respiratory and Critical Care Medicine, The Third Hospital of Changsha, Changsha, Hunan, China.
⁸ Department of Respiratory and Critical Care Medicine, No.1 Traditional Chinese Medicine Hospital of Changde City, Changde, Hunan, China.
⁹ Department of Respiratory and Critical Care Medicine, The First People's Hospital of Huaihua City, Huaihua, Hunan, China.
¹⁰ Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan 410011, China.
¹¹ Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China.
¹² Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan 410011, China.

Abstract

Background and aims: Various prediction indices based on the single time point observation have been proposed in chronic obstructive pulmonary disease (COPD), but little was known about disease trajectory as a predictor of future exacerbations. Our study explored the association between disease trajectory and future exacerbations, and validated the predictive value of the modified and simplified short-term clinically important deterioration (CID).

Methods: This study was a multicenter, prospective observational study. Patients with COPD were recruited into our study and followed up for 18 months. The modified CID (CID-C) was defined as a decrease of 100 mL in forced expiratory volume in 1 second (FEV1), or suffering exacerbations, or increase of 2 units in COPD Assessment Test (CAT) during the first 6 months follow-up. Simplified CID was defined when excluding CAT from the CID-C model.

Results: A total of 127 patients were enrolled in our final analysis. Compared with patients without exacerbations during the period of the 6th to the 18th month, patients with exacerbations were more likely to have frequent short-term exacerbations in the first 6 months (2.14 versus 0.21, p < 0.001). The short-term exacerbations were the best predictor for future exacerbations [odds ratio (OR): 13.25; 95% confidence interval: 5.62-34.67; p < 0.001], followed by the history of exacerbation before study entry, short-term changes in FEV1 and CAT. CID-C and Simplified CID were both significantly associated with exacerbations (OR: 7.14 and 9.74, both p < 0.001). The receiver operating characteristic curves showed that the Simplified CID had slightly better predictive capacity for future exacerbation than CID-C (0.754 versus 0.695, p = 0.02).

Conclusion: Disease trajectory, including both the CID-C and the Simplified CID had significant predictive value for future exacerbations.The reviews of this paper are available via the supplemental material section.

Keywords: chronic obstructive pulmonary disease; clinically important deterioration; exacerbation; predictor; prevention.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Clinical Deterioration*
Disease Progression
Female
Follow-Up Studies
Forced Expiratory Volume / physiology*
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive / physiopathology*