Chronic obstructive pulmonary disease (COPD) assessment test scores corresponding to modified Medical Research Council grades among COPD patients
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: In assigning patients with chronic obstructive pulmonary disease (COPD) to subgroups according to the updated guidelines of the Global Initiative for Chronic Obstructive Lung Disease, discrepancies have been noted between the COPD assessment test (CAT) criteria and modified Medical Research Council (mMRC) criteria. We investigated the determinants of symptom and risk groups and sought to identify a better CAT criterion. Methods: This retrospective study included COPD patients seen between June 20, 2012, and December 5, 2012. The CAT score that can accurately predict an mMRC grade ≥ 2 versus < 2 was evaluated by comparing the area under the receiver operating curve (AUROC) and by classification and regression tree (CART) analysis. Results: Among 428 COPD patients, the percentages of patients classified into subgroups A, B, C, and D were 24.5%, 47.2%, 4.2%, and 24.1% based on CAT criteria and 49.3%, 22.4%, 8.9%, and 19.4% based on mMRC criteria, respectively. More than 90% of the patients who met the mMRC criteria for the ‘more symptoms group’ also met the CAT criteria. AUROC and CART analyses suggested that a CAT score ≥ 15 predicted an mMRC grade ≥ 2 more accurately than the current CAT score criterion. During follow-up, patients with CAT scores of 10 to 14 did not have a different risk of exacerbation versus those with CAT scores < 10, but they did have a lower exacerbation risk compared to those with CAT scores of 15 to 19. Conclusions: A CAT score ≥ 15 is a better indicator for the ‘more symptoms group’ in the management of COPD patients.
Abstract
Background/Aims: In assigning patients with chronic obstructive pulmonary disease (COPD) to subgroups according to the updated guidelines of the Global Initiative for Chronic Obstructive Lung Disease, discrepancies have been noted between the COPD assessment test (CAT) criteria and modified Medical Research Council (mMRC) criteria. We investigated the determinants of symptom and risk groups and sought to identify a better CAT criterion. Methods: This retrospective study included COPD patients seen between June 20, 2012, and December 5, 2012. The CAT score that can accurately predict an mMRC grade ≥ 2 versus < 2 was evaluated by comparing the area under the receiver operating curve (AUROC) and by classification and regression tree (CART) analysis. Results: Among 428 COPD patients, the percentages of patients classified into subgroups A, B, C, and D were 24.5%, 47.2%, 4.2%, and 24.1% based on CAT criteria and 49.3%, 22.4%, 8.9%, and 19.4% based on mMRC criteria, respectively. More than 90% of the patients who met the mMRC criteria for the ‘more symptoms group’ also met the CAT criteria. AUROC and CART analyses suggested that a CAT score ≥ 15 predicted an mMRC grade ≥ 2 more accurately than the current CAT score criterion. During follow-up, patients with CAT scores of 10 to 14 did not have a different risk of exacerbation versus those with CAT scores < 10, but they did have a lower exacerbation risk compared to those with CAT scores of 15 to 19. Conclusions: A CAT score ≥ 15 is a better indicator for the ‘more symptoms group’ in the management of COPD patients.
참고문헌 (23)
- "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease" (2013)[URL]
- "Guidelines for chronic obstructive pulmonary disease 2012" (2007)[URL]
- Zhou QT, "Chronic obstructive pulmonary disease assessment test score correlated with dyspnea score in a large sample of Chinese patients", Chin Med J (Engl), 126, pp.11~15 (2013)
- Han MK, "2011 disease severity classification in COPDGene: a prospective cohort study", Lancet Respir Med, 1, pp.43~50 (2013)
- Kirkpatrick d P, "Racial and sex differences in chronic obstructive pulmonary disease susceptibility, diagnosis, and treatment", Curr Opin Pulm Med, 15, pp.100~104 (2009)
- Dransfield MT, "COPD: racial disparities in susceptibility, treatment, and outcomes", Clin Chest Med, 27, pp.463~471 (2006)
- Barnes PJ., "Genetics and pulmonary medicine. 9. Molecular genetics of chronic obstructive pulmonary disease", Thorax, 54, pp.245~252 (1999)
- Hegab AE, "CLCA1 gene polymorphisms in chronic obstructive pulmonary disease", J Med Genet, 41, pp.e27~ (2004)
- Ho LI, "Polymorphism of the beta(2)-adrenoceptor in COPD in Chinese subjects", Chest, 120, pp.1493~1499 (2001)
- Celli BR, "Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study", Am J Respir Crit Care Med, 178, pp.332~338 (2008)
- Hansel NN, "Racial differences in CT phenotypes in COPD", COPD, 10, pp.20~27 (2013)
- Kwon N, "Validity of the COPD assessment test translated into local languages for Asian patients", Chest, 143, pp.703~710 (2013)
- Breiman L, "Classification and Regression Trees" (1984), Wadsworth International Group
- Pilote L, "Determinants of the use of coronary angiography and revascularization after thrombolysis for acute myocardial infarction", N Engl J Med, 335, pp.1198~1205 (1996)
- Small M, "Quantification and treatment patterns of real-world patients classified by the GOLD 2011 strategy", Thorax, 67, pp.A144~A145 (2012)
- Adamek L, "GOLD 2011:combined COPD assessment of patients from the European health-related quality of life study", Eur Respir J, 40(Suppl 56), pp.1644~ (2012)
- Celli BR, "The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease", N Engl J Med, 350, pp.1005~1012 (2004)
- Puhan MA, "Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index", Lancet, 374, pp.704~711 (2009)
- Jones PW, "Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT) scores", BMC Pulm Med, 11, pp.42~ (2011)
- Lemon SC, "Classification and regression tree analysis in public health: methodological review and comparison with logistic regression", Ann Behav Med, 26, pp.172~181 (2003)
- Decramer M, "New horizons in early stage COPD: improving knowledge, detection and treatment", Respir Med, 105, pp.1576~1587 (2011)
- Anthonisen NR, "Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1:the Lung Health Study", JAMA, 272, pp.1497~1505 (1994)
- Decramer M, "Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial", Lancet, 374, pp.1171~1178 (2009)