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dc.contributor.authorGuerra, Beniaminoen_US
dc.contributor.authorHaile, Sarah R.en_US
dc.contributor.authorLamprecht, Bernden_US
dc.contributor.authorRamírez, Ana S.en_US
dc.contributor.authorMartinez-Camblor, Pabloen_US
dc.contributor.authorKaiser, Bernharden_US
dc.contributor.authorAlfageme, Inmaculadaen_US
dc.contributor.authorAlmagro, Pereen_US
dc.contributor.authorCasanova, Ciroen_US
dc.contributor.authorEsteban-González, Cristóbalen_US
dc.contributor.authorSoler-Cataluña, Juan J.en_US
dc.contributor.authorde-Torres, Juan P.en_US
dc.contributor.authorMiravitlles, Marcen_US
dc.contributor.authorCelli, Bartolomé R.en_US
dc.contributor.authorMarin, Jose M.en_US
dc.contributor.authorter Riet, Gerbenen_US
dc.contributor.authorSobradillo, Patriciaen_US
dc.contributor.authorLange, Peteren_US
dc.contributor.authorGarcia-Aymerich, Judithen_US
dc.contributor.authorAntó, Jósep Mariaen_US
dc.contributor.authorTurner, Alice M.en_US
dc.contributor.authorHan, Meilan K.en_US
dc.contributor.authorLanghammer, Arnulfen_US
dc.contributor.authorLeivseth, Lindaen_US
dc.contributor.authorBakke, Per S.en_US
dc.contributor.authorJohannessen, Aneen_US
dc.contributor.authorOga, Toruen_US
dc.contributor.authorCosio, Borjaen_US
dc.contributor.authorAncochea-Bermúdez, Julioen_US
dc.contributor.authorEchazarreta, Andrésen_US
dc.contributor.authorRoche, Nicolasen_US
dc.contributor.authorBurgel, Pierre-Régisen_US
dc.contributor.authorSin, Don D.en_US
dc.contributor.authorSoriano, Joan B.en_US
dc.contributor.authorPuhan, Milo A.en_US
dc.PublishedGuerra, Haile, Lamprecht B, Ramírez AS, Martinez-Camblor P, Kaiser B, Alfageme I, Almagro P, Casanova C, Esteban-González, Soler-Cataluña JJ, de-Torres JP, Miravitlles M, Celli BR, Marin JM, ter Riet, Sobradillo P, Lange P, Garcia-Aymerich J, Antó JM, Turner AM, Han MK, Langhammer A, Leivseth L, Bakke PS, Johannessen A, Oga T, Cosio B, Ancochea-Bermúdez, Echazarreta A, Roche N, Burgel P, Sin DD, Soriano JB, Puhan MA. Large-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary disease. BMC Medicine. 2018;16:33eng
dc.description.abstractBackground: 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.en_US
dc.publisherBioMed Centraleng
dc.rightsAttribution CC BYeng
dc.subjectPrognostic scoreseng
dc.subjectLarge-scale external validationeng
dc.subjectPerformance comparisoneng
dc.subjectNetwork meta-analysiseng
dc.titleLarge-scale external validation and comparison of prognostic models: An application to chronic obstructive pulmonary diseaseen_US
dc.typePeer reviewed
dc.typeJournal article
dc.rights.holderCopyright 2018 The Author(s)
dc.source.journalBMC Medicine

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