title: Multidimensional prognostic indices for use in COPD patient care. A systematic review.
abstract: BACKGROUND
  A growing number of prognostic indices for chronic obstructive pulmonary disease (COPD) is developed for clinical use. Our aim is to identify, summarize and compare all published prognostic COPD indices, and to discuss their performance, usefulness and implementation in daily practice.
  
  
  METHODS
  We performed a systematic literature search in both Pubmed and Embase up to September 2010. Selection criteria included primary publications of indices developed for stable COPD patients, that predict future outcome by a multidimensional scoring system, developed for and validated with COPD patients only. Two reviewers independently assessed the index quality using a structured screening form for systematically scoring prognostic studies.
  
  
  RESULTS
  Of 7,028 articles screened, 13 studies comprising 15 indices were included. Only 1 index had been explored for its application in daily practice. We observed 21 different predictors and 7 prognostic outcomes, the latter reflecting mortality, hospitalization and exacerbation. Consistent strong predictors were FEV1 percentage predicted, age and dyspnoea. The quality of the studies underlying the indices varied between fairly poor and good. Statistical methods to assess the predictive abilities of the indices were heterogenic. They generally revealed moderate to good discrimination, when measured.
  
  
  CONCLUSIONS
  We focused on prognostic indices for stable disease only and, inevitably, quality judgment was prone to subjectivity.
  
  
  CONCLUSIONS
  We identified 15 prognostic COPD indices. Although the prognostic performance of some of the indices has been validated, they all lack sufficient evidence for implementation. Whether or not the use of prognostic indices improves COPD disease management or patients' health is currently unknown; impact studies are required to establish this.
authors.affiliation: Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, the Netherlands. w.vandijk@aios.umcn.nl
authors.forename: Wouter D van
authors.initials: WD
authors.lastname: Dijk
authors.forename: Lisette van den
authors.initials: Lv
authors.lastname: Bemt
authors.forename: Saskia van den
authors.initials: Sv
authors.lastname: Haak-Rongen
authors.forename: Erik
authors.initials: E
authors.lastname: Bischoff
authors.forename: Chris van
authors.initials: Cv
authors.lastname: Weel
authors.forename: Johannes C C M in 't
authors.initials: JC
authors.lastname: Veen
authors.forename: Tjard R J
authors.initials: TR
authors.lastname: Schermer
mesh_terms: D003627:Data Interpretation, Statistical; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000401:mortality*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate
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