02931nas a2200313 4500008004100000022001400041245013200055210006900187260000900256490000600265520193300271100001902204700002102223700002502244700001802269700001702287700002002304700002002324700002202344700001702366700002902383700001902412700002002431700002202451700002102473700002802494710005902522856003602581 2012 eng d a2044-605500aLarge-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts.0 aLargescale international validation of the ADO index in subjects c20120 v23 a

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 FEV(1) 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 FEV(1) 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 FEV(1) 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.

1 aPuhan, Milo, A1 aHansel, Nadia, N1 aSobradillo, Patricia1 aEnright, Paul1 aLange, Peter1 aHickson, Demarc1 aMenezes, Ana, M1 aRiet, Gerben, ter1 aHeld, Ulrike1 aDomingo-Salvany, Antonia1 aMosenifar, Zab1 aAntó, Josep, M1 aMoons, Karel, G M1 aKessels, Alphons1 aGarcia-Aymerich, Judith1 aInternational COPD Cohorts Collaboration Working Group uhttps://chs-nhlbi.org/node/7378