抽象的
BackgroundIn contemporary management of COPD, the frequent exacerbator phenotype based on a 12-month history of acute exacerbations (AECOPD) is a major determinant of therapeutic recommendations. However, there is considerable debate on the stability of this phenotype over time.
方法我们使用——-基本原则event analysis to demonstrate that variation in the frequent exacerbator phenotype has two major sources: variability in the underlying AECOPD rate and the randomness in the occurrence of individual AECOPDs. We re-analysed data from two large cohorts (ECLIPSE and SPIROMICS) using a Bayesian model that separated these sources of variability. We then evaluated the stability of the frequent exacerbator phenotype based on these results.
结果In both cohorts, the pattern of AECOPDs strongly supported the presence of an individual-specific underlying AECOPD rate which is stable over time (Bayes Factor <0.001). Despite this, the observed AECOPD rate can markedly vary year-to-year within individual patients. For those with an underlying rate between 0.8–3.1/year, the frequent exacerbator classification, based on the observed rate, changes >30% of the time over two consecutive years due to chance alone. This value increases to >45% for those with an underlying rate between 1.2–2.2/year.
结论尽管基础AECOPD速率是稳定的性状,但基于观察到的AECOPD模式的频繁恶化表型是不稳定的,因此应质疑其适合治疗决策的适合性。是否需要评估较长持续时间的AECOPD历史记录或使用多元预测模型的使用都需要评估更稳定的表型。
脚注
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利益冲突:Sadatsafavi博士没有什么可披露的。
Conflict of interest: Dr. McCormack has nothing to disclose.
Conflict of interest: Dr. Petkau has nothing to disclose.
Conflict of interest: Dr. Lynd has nothing to disclose.
Conflict of interest: Mr. Lee has nothing to disclose.
利益冲突:SIN博士报告了阿斯利康(Astrazeneca)的赠款和个人费用,Boehringer Ingelheim的个人费用,Ikomed的赠款,在提交的工作之外。
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- 已收到2020年6月2日。
- Accepted2020年8月17日。
- 复制right ©ERS 2020