title: Risk of exacerbation in chronic obstructive pulmonary disease: a primary care retrospective cohort study.
abstract: BACKGROUND
  The risk of exacerbation in chronic obstructive pulmonary disease (COPD) depends on the severity of disease and other less well known factors. Predictive models of exacerbation are more accurate than the forced expiratory volume in one second (FEV1). The objective was to design a model that predicts the risk of exacerbation in COPD.
  
  
  METHODS
  Retrospective cohort study with data from the electronic medical records of patients diagnosed with COPD in the province of Lleida (Spain). A total of 2501 patients were followed during 3 years. The dependent variable was acute exacerbation; independent variables were: clinical parameters, spirometry results, severity of disease, influenza and 23-valent pneumococcal immunisation, comorbidities, smoking and history of exacerbation. The association of these variables with disease exacerbation was measured by the adjusted odds ratio using a logistic regression model.
  
  
  RESULTS
  Mean age at the start of the study was 68.38 years (SD = 11.60) and 74.97% patients were men; severity of disease was considered mild in 50.82% of patients, moderate in 35.31%, severe in 9.44% and very severe in 4.44%. During the three year study period up to 83.17% of patients experienced at least one exacerbation. Predictive factors in the model were age, gender, previous exacerbations, influenza and 23-valent pneumococcal immunisations, number of previous visits to the General Practice and severity (GOLD), with an area under the ROC curve (AUROC) of 0.70.
  
  
  CONCLUSIONS
  This model can identify patients at high risk of acute exacerbation. Preventive measures and modification of treatment in these high-risk patients would improve survival.
authors.affiliation: Biomedical Research Institute (IRB) of Lleida, Lleida, Catalonia, Spain. jmontser@alumni.unav.es.|Health Department, Public Health Agency of Catalonia, Lleida, Catalonia, Spain. jmontser@alumni.unav.es.|Catalan Institute of Health (ICS), Mollerussa/Lleida, Catalonia, Spain. jmontser@alumni.unav.es.
authors.forename: Josep
authors.initials: J
authors.lastname: Montserrat-Capdevila
authors.affiliation: Biomedical Research Institute (IRB) of Lleida, Lleida, Catalonia, Spain.|Health Department, Public Health Agency of Catalonia, Lleida, Catalonia, Spain.|Faculty of Medicine, University of Lleida, Lleida, Catalonia, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Godoy
authors.affiliation: Lleida Research Support Unit, Primary Care Research Institute (IDIAP) Jordi Gol. Autonomous University of Barcelona, Lleida, Catalonia, Spain.|Cardiovascular Department, Epidemiology Unit, University Hospital Vall d'Hebron, Barcelona, Catalonia, Spain.
authors.forename: Josep Ramon
authors.initials: JR
authors.lastname: Marsal
authors.affiliation: Biomedical Research Institute (IRB) of Lleida, Lleida, Catalonia, Spain.|Catalan Institute of Health (ICS), Mollerussa/Lleida, Catalonia, Spain.|Faculty of Medicine, University of Lleida, Lleida, Catalonia, Spain.|Pneumology Unit, University Hospital Arnau de Vilanova, Lleida, Catalonia, Spain.|Biomedical Research Centre Network for Respiratory Diseases (CIBERES), Madrid, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Barbé
authors.affiliation: Pharmacy Unit. Catalan Health Service, Lleida, Catalonia, Spain.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Galván
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology