ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), IMIM (Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP)
Alice M. Turner
Institute of Applied Health Research, University of Birmingham
Meilan K. Han
Division of Pulmonary and Critical Care, University of Michigan
Arnulf Langhammer
Department of Public Health and Nursing, Norvegian University of Science and Technology
Linda Leivseth
Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority
Per Bakke
University of Bergen, Haukeland University Hospital
Ane Johannessen
Department of Global Public Health and Primary Care, University of Bergen
Toru Oga
Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University
Borja Cosio
Department of Respiratory Medicine, Hospital Son Espases-IdISBa-CIBERES
Julio Ancochea-Bermúdez
Instituto de Investigación Sanitaria Princesa (IISP)-Servicio de Neumología- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid
Andres Echazarreta
Universidad Nacional de la Plata, Hospital San Juan de Dios de La Plata
Nicolas Roche
Hopitaux Universitaires Paris Centre, Service de Pneumologie AP-HP
Pierre-Régis Burgel
Hopital Cochin; Universite Paris Descartes
Don D. Sin
University of British Columbia, James Hogg Research Centre
Joan B. Soriano
Instituto de Investigación del Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Servicio de Neumología
Milo A. Puhan
Epidemiology, Biostatistics and Prevention Institute, University of Zurich
Abstract Background External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores for 3-year all-cause mortality in mostly multimorbid patients with COPD. Methods We relied on 24 cohort studies of the COPD Cohorts Collaborative International Assessment consortium, corresponding to primary, secondary, and tertiary care in Europe, the Americas, and Japan. These studies include globally 15,762 patients with COPD (1871 deaths and 42,203 person years of follow-up). We used network meta-analysis adapted to multiple score comparison (MSC), following a frequentist two-stage approach; thus, we were able to compare all scores in a single analytical framework accounting for correlations among scores within cohorts. We assessed transitivity, heterogeneity, and inconsistency and provided a performance ranking of the prognostic scores. Results Depending on data availability, between two and nine prognostic scores could be calculated for each cohort. The BODE score (body mass index, airflow obstruction, dyspnea, and exercise capacity) had a median area under the curve (AUC) of 0.679 [1st quartile–3rd quartile = 0.655–0.733] across cohorts. The ADO score (age, dyspnea, and airflow obstruction) showed the best performance for predicting mortality (difference AUCADO – AUCBODE = 0.015 [95% confidence interval (CI) = −0.002 to 0.032]; p = 0.08) followed by the updated BODE (AUCBODE updated – AUCBODE = 0.008 [95% CI = −0.005 to +0.022]; p = 0.23). The assumption of transitivity was not violated. Heterogeneity across direct comparisons was small, and we did not identify any local or global inconsistency. Conclusions Our analyses showed best discriminatory performance for the ADO and updated BODE scores in patients with COPD. A limitation to be addressed in future studies is the extension of MSC network meta-analysis to measures of calibration. MSC network meta-analysis can be applied to prognostic scores in any medical field to identify the best scores, possibly paving the way for stratified medicine, public health, and research.
