title: The predictive value of an adjusted COPD assessment test score on the risk of respiratory-related hospitalizations in severe COPD patients.
abstract: We evaluated whether a chronic obstructive pulmonary disease (COPD) assessment test (CAT) with adjusted weights for the CAT items could better predict future respiratory-related hospitalizations than the original CAT. Two focus groups (respiratory nurses and physicians) generated two adjusted CAT algorithms. Two multivariate logistic regression models for infrequent (≤1/year) versus frequent (>1/year) future respiratory-related hospitalizations were defined: one with the adjusted CAT score that correlated best with future hospitalizations and one with the original CAT score. Patient characteristics related to future hospitalizations ( p ≤ 0.2) were also entered. Eighty-two COPD patients were included. The CAT algorithm derived from the nurse focus group was a borderline significant predictor of hospitalization risk (odds ratio (OR): 1.07; 95% confidence interval (CI): 1.00-1.14; p = 0.050) in a model that also included hospitalization frequency in the previous year (OR: 3.98; 95% CI: 1.30-12.16; p = 0.016) and anticholinergic risk score (OR: 3.08; 95% CI: 0.87-10.89; p = 0.081). Presence of ischemic heart disease and/or heart failure appeared 'protective' (OR: 0.17; 95% CI: 0.05-0.62; p = 0.007). The original CAT score was not significantly associated with hospitalization risk. In conclusion, as a predictor of respiratory-related hospitalizations, an adjusted CAT score was marginally significant (although the original CAT score was not). 'Previous respiratory-related hospitalizations' was the strongest factor in this equation.
authors.affiliation: 1 Faculty of Medical Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.|2 Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Sloots
authors.affiliation: 3 School of Health Sciences, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Barton
authors.affiliation: 4 Department of Respiratory Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Buckman
authors.affiliation: 5 Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Bassett
authors.affiliation: 6 Department of Research Methodology, University of Twente, Measurement and Data Analysis, Enschede, The Netherlands.|7 Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: 5 Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Frith
authors.affiliation: 4 Department of Respiratory Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia.|5 Department of Respiratory Medicine, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: Tanja W
authors.initials: TW
authors.lastname: Effing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology; D015444:Exercise; D017079:Exercise Tolerance; D005260:Female; D017144:Focus Groups; D005541:Forced Expiratory Volume; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology; D009726:Nurses; D016017:Odds Ratio; D011237:Predictive Value of Tests; D065840:Protective Factors; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D000072106:Pulmonologists; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D018680:Cholinergic Antagonists
keywords: COPD assessment test; Chronic obstructive pulmonary disease; focus groups; hospitalizations; predictive value of tests; questionnaires; risk factors