{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:35:26Z","timestamp":1792564526868,"version":"4.5.0"},"reference-count":45,"publisher":"BMJ","funder":[{"DOI":"10.13039\/100014129","name":"Respiratory Effectiveness Group","doi-asserted-by":"publisher","award":["No award\/grant number"],"award-info":[{"award-number":["No award\/grant number"]}],"id":[{"id":"10.13039\/100014129","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PHT 178432"],"award-info":[{"award-number":["PHT 178432"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Efficient preventive management of acute exacerbation of chronic obstructive pulmonary disease (COPD) is predicated on accurate risk stratification. We compared the performance of exacerbation history (current standard of care) versus a revised version of a multivariable risk scoring tool (Acute COPD Exacerbation Prediction Tool (ACCEPT)) using primary-care UK data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used validated case definitions to identify diagnosed patients with COPD \u226540 years old from the UK Clinical Practice Research Datalink Aurum (2004\u20132020). For each patient, a single annual COPD visit was randomly selected as the index date. The outcome was the occurrence of \u22651 moderate\/severe exacerbation(s) within a year of the index date. We conducted time-to-event analyses of the latest version of ACCEPT (ACCEPT 2.0) and developed a recalibrated version (ACCEPT 3.0-UK). Model performance was evaluated using discrimination (time-dependent area under the receiver operating characteristic curve (AUC)), calibration and net benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final cohort included 158\u2009384 patients (55.0% male; mean age 71.5 years). ACCEPT 2.0 achieved an AUC of 0.77 for predicting moderate\/severe exacerbations, outperforming both any and frequent exacerbator categories (AUC: 0.69 and 0.67, respectively). However, it overpredicted exacerbation events (observed-to-expected (O\/E) ratio: 0.81 (95% CI 0.80 to 0.81)). Recalibration resolved this overprediction, yielding O\/E ratio of 1.00 (95% CI 0.99 to 1.00), while maintaining discrimination (AUC: 0.77). ACCEPT 3.0-UK was net beneficial and superior to exacerbation history across a wide range of risk thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ACCEPT 3.0-UK has substantially higher performance than exacerbation history, quantifies predicted risks for shared decision-making and is likely to confer clinical utility for risk stratification in primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thorax-2026-224814","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:20:21Z","timestamp":1782321621000},"page":"thorax-2026-224814","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Performance of multivariable risk prediction algorithms in predicting COPD exacerbations: a population-based 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Emil","family":"Amegadzie","sequence":"additional","affiliation":[{"name":"The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada"},{"name":"BCCDC, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2205-2683","authenticated-orcid":false,"given":"Mary A","family":"De Vera","sequence":"additional","affiliation":[{"name":"The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada"},{"name":"Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5637-6053","authenticated-orcid":false,"given":"Michael R","family":"Law","sequence":"additional","affiliation":[{"name":"Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"Centre for Health Policy, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0756-6643","authenticated-orcid":false,"given":"Don D","family":"Sin","sequence":"additional","affiliation":[{"name":"The University of British Columbia Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-4497","authenticated-orcid":false,"given":"Surya P","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Center for Lung Analytics and Imaging Research, and Division of Pulmonary, 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