ArticleBMC medicine2018
Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease.
Article in BMC medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal.BMJ (Clinical research ed.) · 2019Pooled it
- Predictive models for mortality readmission events and cardiovascular complications in patients with COPD: a systematic review and meta-analysis.ERJ open research · 2026Article
- Prognostic score for predicting respiratory admissions among patients with chronic obstructive pulmonary disease in primary care: development and validation in population cohorts (Birmingham Lung Improvement Studies (BLISS)).BMJ (Clinical research ed.) · 2026Observational
- The Disproportionate Burden of Cardiovascular Disease in Mild-to-Moderate COPD.International journal of chronic obstructive pulmonary disease · 2026Article
- Integrated multi-omics profiling for risk stratification in Asians with COPD.Respiratory research · 2025Article
- Decoding Diagnostic Delay in COPD: An Integrative Analysis of Missed Opportunities, Clinical Risk Profiles, and Targeted Detection Strategies in Primary Care.Diagnostics (Basel, Switzerland) · 2025Article
- Development and validation of a mortality risk prediction model for chronic obstructive pulmonary disease: a cross-sectional study using probabilistic graphical modelling.EClinicalMedicine · 2024Article
- Transparent reporting of multivariable prediction models developed or validated using clustered data (TRIPOD-Cluster): explanation and elaboration.BMJ (Clinical research ed.) · 2023Article
- Dementia risk in the general population: large-scale external validation of prediction models in the AGES-Reykjavik study.European journal of epidemiology · 2021Article
- Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2015 and GOLD 2019 staging: a pooled analysis of individual patient data.ERJ open research · 2020Article
- A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2020Article
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- The stability of the ADO score among UK COPD patients from The Health Improvement Network.ERJ open research · 2020Article
- The prognostic significance of weight loss in chronic obstructive pulmonary disease-related cachexia: a prospective cohort study.Journal of cachexia, sarcopenia and muscle · 2019Article
- External Validation Of The Updated ADO Score In COPD Patients From The Birmingham COPD Cohort.International journal of chronic obstructive pulmonary disease · 2019Article
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Authors and funding
36 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundExternal 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.
methodsWe 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.
resultsDepending 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 AUC
conclusionsOur 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.
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