{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:16:13Z","timestamp":1790054173100,"version":"4.0.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T00:00:00Z","timestamp":1617667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> In patients with chronic obstructive pulmonary disease (COPD), acute exacerbations affect patients' health and can lead to death. This study was aimed to develop a prediction model for in-hospital mortality in patients with acute exacerbations of COPD (AECOPD).<\/jats:p><jats:p><jats:bold>Method:<\/jats:bold> A retrospective study was performed in patients hospitalized for AECOPD between 2015 and 2019. Patients admitted between 2015 and 2017 were included to develop model and individuals admitted in the following 2 years were included for external validation. We analyzed variables that were readily available in clinical practice. Given that death was a rare outcome in this study, we fitted Firth penalized logistic regression. C statistic and calibration plot quantified the model performance. Optimism-corrected C statistic and slope were estimated by bootstrapping. Accordingly, the prediction model was adjusted and then transformed into risk score.<\/jats:p><jats:p><jats:bold>Result:<\/jats:bold> Between 2015 and 2017, 1,096 eligible patients were analyzed, with a mean age of 73 years and 67.8% male. The in-hospital mortality was 2.6%. Compared to survivors, non-survivors were older, more admitted from emergency, more frequently concomitant with respiratory failure, pneumothorax, hypoxic-hypercarbic encephalopathy, and had longer length of stay (LOS). Four variables were included into the final model: age, respiratory failure, pneumothorax, and LOS. In internal validation, C statistic was 0.9147, and the calibration slope was 1.0254. Their optimism-corrected values were 0.90887 and 0.9282, respectively, indicating satisfactory discrimination and calibration. When externally validated in 700 AECOPD patients during 2018 and 2019, the model demonstrated good discrimination with a C statistic of 0.8176. Calibration plot illustrated a varying discordance between predicted and observed mortality. It demonstrated good calibration in low-risk patients with predicted mortality rate \u226410% (<jats:italic>P<\/jats:italic> = 0.3253) but overestimated mortality in patients with predicted rate &amp;gt;10% (<jats:italic>P<\/jats:italic> &amp;lt; 0.0001). The risk score of 20 was regarded as a threshold with an optimal Youden index of 0.7154.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> A simple prediction model for AECOPD in-hospital mortality has been developed and externally validated. Based on available data in clinical setting, the model could serve as an easily used instrument for clinical decision-making. Complications emerged as strong predictors, underscoring an important role of disease management in improving patients' prognoses during exacerbation episodes.<\/jats:p>","DOI":"10.3389\/fmed.2021.630870","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T04:16:00Z","timestamp":1617682560000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Development and Validation of Risk Prediction Model for In-hospital Mortality Among Patients Hospitalized With Acute Exacerbation Chronic Obstructive Pulmonary Disease Between 2015 and 2019"],"prefix":"10.3389","volume":"8","author":[{"given":"Fen","family":"Dong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxia","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjun","family":"Jiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,4,6]]},"reference":[{"key":"B1","unstructured":"SeattleInstitute for Health Metrics and Evaluation (IHME)Global Burden of Disease Study 2017 (GBD 2017) Results2018"},{"key":"B2","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1136\/thx.2005.041806","article-title":"COPD exacerbations 1: epidemiology","volume":"61","author":"Donaldson","year":"2006","journal-title":"Thorax"},{"key":"B3","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1378\/chest.10-1393","article-title":"COPD in China: the burden and importance of proper management","volume":"139","author":"Fang","year":"2011","journal-title":"Chest"},{"key":"B4","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1136\/thx.2005.040527","article-title":"Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease","volume":"60","author":"Soler-Cataluna","year":"2005","journal-title":"Thorax"},{"key":"B5","doi-asserted-by":"publisher","first-page":"b375","DOI":"10.1136\/bmj.b375","article-title":"Prognosis and prognostic research: what, why, and how?","volume":"338","author":"Moons","year":"2009","journal-title":"BMJ"},{"key":"B6","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/j.ejcdt.2016.03.003","article-title":"Predicting in-hospital mortality in acute exacerbation of COPD: is there a golden score?","volume":"65","author":"Yousif","year":"2016","journal-title":"Egypt J Chest Dis Tuberc"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1016\/S0140-6736(18)30841-9","article-title":"Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study","volume":"391","author":"Wang","year":"2018","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/1471-2296-14-11","article-title":"Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study","volume":"14","author":"Garc\u00eda-Olmos","year":"2013","journal-title":"BMC Family Practice"},{"key":"B9","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1183\/09059180.00008612","article-title":"Comorbidities of COPD","volume":"22","author":"Cavailles","year":"2013","journal-title":"Eur Respir Rev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1183\/09031936.00081409","article-title":"Infection as a comorbidity of COPD","volume":"35","author":"Sethi","year":"2010","journal-title":"Eur Respir J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"m441","DOI":"10.1136\/bmj.m441","article-title":"Calculating the sample size required for developing a clinical prediction model","volume":"368","author":"Riley","year":"2020","journal-title":"BMJ"},{"key":"B12","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1093\/ejcts\/ezy180","article-title":"Statistical primer: developing and validating a risk prediction model","volume":"54","author":"Grant","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1002\/sim.7992","article-title":"Minimum sample size for developing a multivariable prediction model: PART II\u2014binary and time-to-event outcomes","volume":"38","author":"Riley","year":"2019","journal-title":"Stat Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"h3868","DOI":"10.1136\/bmj.h3868","article-title":"How to develop a more accurate risk prediction model when there are few events","volume":"351","author":"Pavlou","year":"2015","journal-title":"BMJ"},{"key":"B15","doi-asserted-by":"publisher","first-page":"W1","DOI":"10.7326\/M14-0698","article-title":"Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): Explanation and Elaboration","volume":"162","author":"Moons","year":"2015","journal-title":"Ann Intern Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1002\/sim.1742","article-title":"RBDA. Presentation of multivariate data for clinical use: the Framingham Study risk score functions","volume":"23","author":"Sullivan","year":"2004","journal-title":"Stat Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1111\/1467-9574.00157","article-title":"Application of shrinkage techniques in logistic regression analysis: a case study","volume":"55","author":"Steyerberg","year":"2001","journal-title":"Stat Neerl"},{"key":"B18","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1136\/thoraxjnl-2012-202103","article-title":"The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease","volume":"67","author":"Steer","year":"2012","journal-title":"Thorax"},{"key":"B19","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/1741-7015-12-66","article-title":"Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments","volume":"12","author":"Quintana","year":"2014","journal-title":"BMC Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e000488","DOI":"10.1136\/bmjresp-2019-000488","article-title":"Prognostic indicators for in-hospital mortality in COPD with acute exacerbation in Thailand: a retrospective cohort study","volume":"7","author":"Morasert","year":"2020","journal-title":"BMJ Open Respir Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/j.jemermed.2020.07.001","article-title":"Acute exacerbations of chronic obstructive pulmonary disease: a primer for emergency physicians","volume":"59","author":"Sorge","year":"2020","journal-title":"J Emerg Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"26s","DOI":"10.1183\/09031936.03.00030103","article-title":"Respiratory failure in chronic obstructive pulmonary disease","volume":"47","author":"Calverley","year":"2003","journal-title":"Eur Respir J Suppl"},{"key":"B23","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1183\/13993003.01391-2014","article-title":"Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD audit","volume":"47","author":"Hartl","year":"2016","journal-title":"Eur Respir J."},{"key":"B24","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/01.CCN.0000525926.13357.c0","article-title":"Acute respiratory failure and COPD: recognition and care","volume":"13","author":"Siela","year":"2018","journal-title":"Nurs Crit Care"},{"key":"B25","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/s0002-9343(99)80374-x","article-title":"Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease","volume":"98","author":"Fuso","year":"1995","journal-title":"Am J Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1378\/chest.121.5.1441","article-title":"Mortality after hospitalization for COPD","volume":"121","author":"Almagro","year":"2002","journal-title":"Chest"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1513\/AnnalsATS.202001-070OC","article-title":"Predicting severe chronic obstructive pulmonary disease exacerbations. Developing a population surveillance approach with administrative data","volume":"17","author":"Tavakoli","year":"2020","journal-title":"Ann Am Thorac Soc"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.630870\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T04:16:04Z","timestamp":1617682564000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.630870\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,6]]},"references-count":27,"alternative-id":["10.3389\/fmed.2021.630870"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.630870","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,6]]},"article-number":"630870"}}