Development and validation of a nomogram model for mortality prediction in stable chronic obstructive pulmonary disease patients: A prospective observational study in the RealDTC cohort

Wei Cheng; Aiyuan Zhou; Qing Song; Yuqin Zeng; Ling Lin; Cong Liu; Jingcheng Shi; Zijing Zhou; Yating Peng; Jing Li; DingDing Deng; Min Yang; Lizhen Yang; Yan Chen; Shan Cai; Ping Chen

doi:10.7189/jogh.14.04049

Development and validation of a nomogram model for mortality prediction in stable chronic obstructive pulmonary disease patients: A prospective observational study in the RealDTC cohort

J Glob Health. 2024 Feb 23:14:04049. doi: 10.7189/jogh.14.04049.

Authors

Wei Cheng^{1

2}, Aiyuan Zhou³, Qing Song^{1

2}, Yuqin Zeng^{1

2}, Ling Lin^{1

2}, Cong Liu^{1

2}, Jingcheng Shi⁴, Zijing Zhou^{1

2}, Yating Peng^{1

2}, Jing Li^{1

2}, DingDing Deng⁵, Min Yang^{1

2}, Lizhen Yang^{1

2}, Yan Chen^{1

2}, Shan Cai^{1

2}, Ping Chen^{1

2}

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Centre of Respiratory Disease, Central South University, Changsha, Hunan, China.
² Clinical Medical Research Centre for Respiratory and Critical Care Medicine in Hunan Province, China.
³ Department of Pulmonary and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁴ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
⁵ Department of Respiratory Medicine, The First Affiliated People's Hospital, Shaoyang College, Shaoyang, Hunan, China.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. There is no nomogram model available for mortality prediction of stable COPD. We intended to develop and validate a nomogram model to predict mortality risk in stable COPD patients for personalised prognostic assessment.

Methods: A prospective observational study was made of COPD outpatients registered in the RealDTC study between December 2016 and December 2019. Patients were randomly assigned to the training cohort and validation cohort in a ratio of 7:3. We used Lasso regression to screen predicted variables. Further, we evaluated the prognostic performance using the area under the time-dependent receiver operating characteristic curve (AUC) and calibration curve. We used the AUC, concordance index, and decision curve analysis to evaluate the net benefits and utility of the nomogram compared with three earlier prediction models.

Results: Of 2499 patients, the median follow-up was 38 months. The characteristics of the patients between the training cohort (n = 1743) and the validation cohort (n = 756) were similar. ABEODS nomogram model, combining age, body mass index, educational level, airflow obstruction, dyspnoea, and severe exacerbation in the first year, was constructed to predict mortality in stable COPD patients. In the integrative analysis of training and validation cohorts of the nomogram model, the three-year mortality prediction achieved AUC = 0.84; 95% confidence interval (CI) = 0.81, 0.88 and AUC = 0.80; 95% CI = 0.74, 0.86, respectively. The ABEODS nomogram model preserved excellent calibration in both the training cohort and validation cohort. The time-dependent AUC, concordance index, and net benefit of the nomogram model were higher than those of BODEx, updated ADO, and DOSE, respectively.

Conclusions: We developed and validated a prognostic nomogram model that accurately predicts mortality across the COPD severity spectrum. The proposed ABEODS nomogram model performed better than earlier models, including BODEx, updated ADO, and DOSE in Chinese patients with COPD.

Registration: ChiCTR-POC-17010431.

Publication types

Randomized Controlled Trial
Observational Study

MeSH terms

Humans
Lung
Nomograms*
Prospective Studies
Pulmonary Disease, Chronic Obstructive*
Risk Assessment