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Discriminative Accuracy of FEV1:FVC Thresholds for COPD-Related Hospitalization and Mortality.
Monday,2019-07-29 13:45 America/Los_Angeles — ecterry
| Title | Discriminative Accuracy of FEV1:FVC Thresholds for COPD-Related Hospitalization and Mortality. |
| Publication Type | Journal Article |
| Year of Publication | 2019 |
| Authors | Bhatt, SP, Balte, PP, Schwartz, JE, Cassano, PA, Couper, D, Jacobs, DR, Kalhan, R, O'Connor, GT, Yende, S, Sanders, JL, Umans, JG, Dransfield, MT, Chaves, PH, White, WB, Oelsner, EC |
| Journal | JAMA |
| Volume | 321 |
| Issue | 24 |
| Pagination | 2438-2447 |
| Date Published | 2019 06 25 |
| ISSN | 1538-3598 |
| Keywords | Aged, Aged, 80 and over, Cohort Studies, Female, Forced Expiratory Volume, Hospitalization, Humans, Male, Middle Aged, Prognosis, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive, Risk Assessment, Vital Capacity |
| Abstract | <p><b>Importance: </b>According to numerous current guidelines, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1:FVC) of less than 0.70, yet this fixed threshold is based on expert opinion and remains controversial.</p><p><b>Objective: </b>To determine the discriminative accuracy of various FEV1:FVC fixed thresholds for predicting COPD-related hospitalization and mortality.</p><p><b>Design, Setting, and Participants: </b>The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 4 US general population-based cohorts (Atherosclerosis Risk in Communities Study; Cardiovascular Health Study; Health, Aging, and Body Composition Study; and Multi-Ethnic Study of Atherosclerosis). Participants aged 45 to 102 years were enrolled from 1987 to 2000 and received follow-up longitudinally through 2016.</p><p><b>Exposures: </b>Presence of airflow obstruction, which was defined by a baseline FEV1:FVC less than a range of fixed thresholds (0.75 to 0.65) or less than the lower limit of normal as defined by Global Lung Initiative reference equations (LLN).</p><p><b>Main Outcomes and Measures: </b>The primary outcome was a composite of COPD hospitalization and COPD-related mortality, defined by adjudication or administrative criteria. The optimal fixed FEV1:FVC threshold was defined by the best discrimination for these COPD-related events as indexed using the Harrell C statistic from unadjusted Cox proportional hazards models. Differences in C statistics were compared with respect to less than 0.70 and less than LLN thresholds using a nonparametric approach.</p><p><b>Results: </b>Among 24 207 adults in the pooled cohort (mean [SD] age at enrollment, 63 [10.5] years; 12 990 [54%] women; 16 794 [69%] non-Hispanic white; 15 181 [63%] ever smokers), complete follow-up was available for 11 077 (77%) at 15 years. During a median follow-up of 15 years, 3925 participants experienced COPD-related events over 340 757 person-years of follow-up (incidence density rate, 11.5 per 1000 person-years), including 3563 COPD-related hospitalizations and 447 COPD-related deaths. With respect to discrimination of COPD-related events, the optimal fixed threshold (0.71; C statistic for optimal fixed threshold, 0.696) was not significantly different from the 0.70 threshold (difference, 0.001 [95% CI, -0.002 to 0.004]) but was more accurate than the LLN threshold (difference, 0.034 [95% CI, 0.028 to 0.041]). The 0.70 threshold provided optimal discrimination in the subgroup analysis of ever smokers and in adjusted models.</p><p><b>Conclusions and Relevance: </b>Defining airflow obstruction as FEV1:FVC less than 0.70 provided discrimination of COPD-related hospitalization and mortality that was not significantly different or was more accurate than other fixed thresholds and the LLN. These results support the use of FEV1:FVC less than 0.70 to identify individuals at risk of clinically significant COPD.</p> |
| DOI | 10.1001/jama.2019.7233 |
| Alternate Journal | JAMA |
| PubMed ID | 31237643 |
| PubMed Central ID | PMC6593636 |
| Grant List | K23 HL133438 / HL / NHLBI NIH HHS / United States RC1 HL100543 / HL / NHLBI NIH HHS / United States N01HC95169 / HL / NHLBI NIH HHS / United States R01 HL093081 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01HC95161 / HL / NHLBI NIH HHS / United States N01HC95168 / HL / NHLBI NIH HHS / United States N01HC95162 / HL / NHLBI NIH HHS / United States N01HC95165 / HL / NHLBI NIH HHS / United States N01HC95167 / HL / NHLBI NIH HHS / United States N01HC95159 / HL / NHLBI NIH HHS / United States N01HC95163 / HL / NHLBI NIH HHS / United States R21 HL129924 / HL / NHLBI NIH HHS / United States N01HC95164 / HL / NHLBI NIH HHS / United States U01 HL130114 / HL / NHLBI NIH HHS / United States N01HC95166 / HL / NHLBI NIH HHS / United States K23 HL130627 / HL / NHLBI NIH HHS / United States N01HC95160 / HL / NHLBI NIH HHS / United States R01 AG028050 / AG / NIA NIH HHS / United States R01 HL077612 / HL / NHLBI NIH HHS / United States R01 NR012459 / NR / NINR NIH HHS / United States |
ePub date:
19/06