A score to predict short-term risk of COPD exacerbations (SCOPEX)

Figures & data

Table 1 Characteristics of all patients with COPD, and by sex

	All patients (n=3,141)	Male (n=2,017)	Female (n=1,124)
Age, years	63.1 (9.2)	63.9 (9.1)	61.7 (9.3)
BMI, kg/m^2	26.7 (5.8)	26.6 (5.3)	26.9 (6.8)
Month since first COPD symptoms	130.0 (85.2)	127.0 (86.2)	124.2 (83.6)
FEV1
Pre-bronchodilator, % predicted	34.6 (10.1)	33.6 (10.0)	36.4 (10.1)
Reversibility, % predicted	5.5 (5.9)	5.1 (5.3)	6.4 (6.7)
Post-bronchodilator, % predicted	40.1 (12.2)	38.7 (11.8)	42.8 (12.5)
Pre-bronchodilator FEV1/FVC ratio, %	47.2 (10.6)	46.1 (10.5)	49.2 (10.6)
COPD severity (GOLD grade), n (%)
II (moderate)	649 (20.7)	340 (16.9)	309 (27.5)
III (severe)	1,770 (56.4)	1,159 (57.5)	611 (54.4)
IV (very severe)	697 (22.2)	506 (25.1)	191 (17.0)
Exacerbations during previous year, n (%)
1	1,886 (60.0)	1,264 (62.7)	622 (55.3)
2	785 (25.0)	486 (24.1)	299 (26.6)
3	258 (8.2)	138 (6.8)	120 (10.7)
4	120 (3.8)	74 (3.7)	46 (4.1)
>4	92 (2.9)	55 (2.7)	37 (3.3)
Smoking history
Median, pack-years (range)	40.0 (10.0–258.0)	44.0 (10.0–258.0)	38.0 (10.0–175.0)
Current smoker, n (%)	1,280 (40.8)	772 (38.3)	508 (45.2)
Ex-smoker, n (%)	1,861 (59.2)	1,245 (61.7)	616 (54.8)
Mean SGRQ total score (range)	55.6 (6.2–100.0)	54.4 (6.2–100.0)	57.6 (10.6–100.0)
Mean reliever use, inhalations per day (range)	4.3 (0.0–33.8)	4.2 (0.0–33.8)	4.4 (0.0–29.9)
Sleep symptom score (0–4)	1.04	1.05	1.01
Number of COPD medications at study entry, n (%)a
0	803 (25.6)	495 (24.5)	308 (27.4)
1	722 (23.0)	468 (23.2)	254 (22.6)
2	987 (31.4)	622 (30.8)	365 (32.5)
3	621 (19.8)	425 (21.1)	196 (17.4)
Comorbidities, n (%)b
0	1,124 (35.8)	751 (37.2)	373 (33.2)
1	1,119 (35.6)	739 (36.6)	380 (33.8)
2	622 (19.8)	374 (18.5)	248 (22.1)
>2	276 (8.8)	153 (7.6)	123 (10.9)

Notes: Data reported as mean and standard deviation, unless stated otherwise. GOLD COPD grades are defined as: grade II = post-bronchodilator FEV₁ 50%–80% of predicted; grade III = post-bronchodilator FEV₁ 30%–50% of predicted; and grade IV = post-bronchodilator FEV₁<30% of predicted.

a Number of COPD maintenance medications at study entry: 0= no maintenance treatment with LA (long-acting β₂-agonists, long-acting antimuscarinics, and theophylline), ICS, or other daily treatments (ie, short-acting [β₂-agonist or antimuscarinic] bronchodilators only), 1= one maintenance medication, 2= two maintenance medications, 3= three or more maintenance medications

b comorbidities – number of comorbidity classes (cardiac-related morbidities [ischemic cardiovascular disease and arteriosclerosis], hypertension, diabetes, depression/anxiety, gastroesophageal reflux disease). Data from.^15–17

Abbreviations: COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LA, long-acting bronchodilators; SGRQ, St George’s Respiratory Questionnaire.

Table 2 Backwards selection modela by Cox regression analysis of predictors for moderate and severe COPD exacerbations for all patients, and by sex

Baseline variable	All patients (n=3,141)		Males only (n=2,017)		Females only (n=1,124)
	HR (95% CI)	Overall P-value	HR (95% CI)	Overall P-value	HR (95% CI)	Overall P-value
Number of COPD maintenance medicationsb
1 vs 0	1.18 (0.98–1.43)	<0.001	1.11 (0.86–1.42)	<0.001	1.33 (0.99–1.77)	<0.001
2 vs 0	1.57 (1.32–1.86)		1.64 (1.31–2.06)		1.50 (1.15–1.96)
3 vs 0	1.91 (1.59–2.30)		1.99 (1.57–2.52)		1.83 (1.35–2.47)
Reliever use, number of inhalations	1.05 (1.04–1.07)	<0.001	1.05 (1.03–1.06)	<0.001	1.05 (1.03–1.08)	<0.001
Number of exacerbations in the previous year
2 vs 1	1.40 (1.21–1.61)	<0.001	1.45 (1.21–1.75)	<0.001
3 vs 1	1.63 (1.33–2.00)		1.74 (1.31–2.31)
4 vs 1	1.70 (1.29–2.24)		1.97 (1.40–2.79)
>4 vs 1	2.07 (1.55–2.78)		2.22 (1.51–3.26)
SGRQ total score					1.01 (1.00–1.02)	<0.001
Pre-bronchodilator FEV1/FVC ratio (per 10%)	0.83 (0.78–0.88)	<0.001	0.98 (0.97–0.99)	<0.01	0.98 (0.97–0.99)	<0.001
Sex, female vs male	1.32 (1.16–1.50)	<0.001

Notes:

a Backward selection starting with all predictors and recursively removing factors with high P-value until all remaining P-values were <0.001. The number of COPD exacerbations during the previous year was not selected for females alone

b number of COPD maintenance medications at study entry: 0= no maintenance treatment with LA (long-acting β₂-agonists, long-acting antimuscarinics, and theophylline), ICS, or other daily treatments (ie, short-acting [β₂-agonist or antimuscarinic] bronchodilators only), 1= one maintenance medication, 2= two maintenance medications, 3= three or more maintenance medications. Data from.^15–17

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; HR, hazard ratio; ICS, inhaled corticosteroids; LA, long-acting bronchodilator; SGRQ, St George’s Respiratory Questionnaire.

Table 3 Risk score formula for COPD exacerbation in the next 6 months

Baseline variable	Score
Sex
Male
Female	10
Number of COPD maintenance medicationsa
0–1
2	12
3	20
Number of exacerbations in previous year
1
2	13
3–4	17
>4	24
FEV1/FVC ratio
≥60%
40%–59%	17
<40%	25
Reliever use, no of inhalations/day
<5
5–10	10
≥10	21

Notes:

a Number of COPD maintenance medications at study entry: 0= no maintenance treatment with LA (long-acting β₂-agonists, long-acting antimuscarinics, and theophylline), ICS, or other daily treatments (ie, short-acting [β₂-agonist or antimuscarinic] bronchodilators only), 1= one maintenance medication, 2= two maintenance medications, 3= three or more maintenance medications.

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; ICS, inhaled corticosteroids; LA, long-acting bronchodilator.

Figure 1 ROC curve based on the five selected predictors (C-index =0.67), the full multivariate model (C-index =0.68) and the individual predictors: post-bronchodilator FEV₁ (C-index =0.62) and the number of COPD exacerbations during the previous year (C-index =0.62).

Abbreviations: COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; ROC, receiver operating characteristic.

Figure 2 Risk of exacerbation in 6 months based on baseline risk score for each treatment group, with the pre-bronchodilator FEV₁/FVC ratio as lung function predictor.

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.

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