A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study.

TitleA Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study.
Publication TypePublication
AuthorsStrand M, Austin E, Moll M, Pratte KA, Regan EA, Hayden LP, Bhatt SP, Boriek AM, Casaburi R, Silverman EK, Fortis S, Ruczinski I, Koegler H, Rossiter HB, Occhipinti M, Hanania NA, Gebrekristos HT, Lynch DA, Kunisaki KM, Young KA, Sieren JC, Ragland M, Hokanson JE, Lutz SM, Make BJ, Kinney GL, Cho MH, Pistolesi M, DeMeo DL, Sciurba FC, Comellas AP, Diaz AA, Barjaktarevic I, Bowler RP, Kanner RE, Peters SP, Ortega VE, Dransfield MT, Crapo JD
JournalChronic Obstr Pulm Dis
Date Published2020 Oct

BACKGROUND: Risk factor identification is a proven strategy in advancing treatments and preventive therapy for many chronic conditions. Quantifying the impact of those risk factors on health outcomes can consolidate and focus efforts on individuals with specific high-risk profiles. Using multiple risk factors and longitudinal outcomes in 2 independent cohorts, we developed and validated a risk score model to predict mortality in current and former cigarette smokers.METHODS: We obtained extensive data on current and former smokers from the COPD Genetic Epidemiology (COPDGene) study at enrollment. Based on physician input and model goodness-of-fit measures, a subset of variables was selected to fit final Weibull survival models separately for men and women. Coefficients and predictors were translated into a point system, allowing for easy computation of mortality risk scores and probabilities. We then used the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) cohort for external validation of our model.RESULTS: Of 9867 COPDGene participants with standard baseline data, 17.6% died over 10 years of follow-up, and 9074 of these participants had the full set of baseline predictors (standard plus 6-minute walk distance and computed tomography variables) available for full model fits. The average age of participants in the cohort was 60 for both men and women, and the average predicted 10-year mortality risk was 18% for women and 25% for men. Model time-integrated area under the receiver operating characteristic curve statistics demonstrated good predictive model accuracy (0.797 average), validated in the external cohort (0.756 average). Risk of mortality was impacted most by 6-minute walk distance, forced expiratory volume in 1 second and age, for both men and women.CONCLUSIONS: Current and former smokers exhibited a wide range of mortality risk over a 10- year period. Our models can identify higher risk individuals who can be targeted for interventions to reduce risk of mortality, for participants with or without chronic obstructive pulmonary disease (COPD) using current Global initiative for obstructive Lung Disease (GOLD) criteria.

Alternate JournalChronic Obstr Pulm Dis
PubMed ID32877963
PubMed Central IDPMC7883903
Grant ListP30 ES005605 / ES / NIEHS NIH HHS / United States
R01 HL133137 / HL / NHLBI NIH HHS / United States
U01 HL089856 / HL / NHLBI NIH HHS / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
/ / COPD Foundation / United States
R01 HL149861 / HL / NHLBI NIH HHS / United States
U01 HL089897 / HL / NHLBI NIH HHS / United States
R01 HL151452 / HL / NHLBI NIH HHS / United States
K23 HL136851 / HL / NHLBI NIH HHS / United States
Manuscript Full Title: 
A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Denver (National Jewish Health)
Manuscript Status: 
Published and Public