近日，英国伯明翰大学Peymane Adab团队研究了预测初级保健中慢性阻塞性肺疾病患者呼吸入院的预后评分。这一研究成果于2026年3月5日发表在国际顶尖学术期刊《英国医学杂志》上。

为了开发并验证（内部与外部）一种预后评分，以预测慢性阻塞性肺疾病患者两年内因呼吸系统疾病入院的风险，研究组在人群队列中进行了模型开发与验证。模型开发与内部验证的数据来自基层医疗新发及现存COPD患者的伯明翰肺部改善研究队列。外部验证的数据来自国际队列中的慢性阻塞性肺疾病纵向评估以识别预测性替代终点研究队列，以及与医院病例统计数据库关联的英国基层医疗临床实践研究数据链Aurum数据库。

参与者为BLISS队列1894例新发及现存COPD患者；ECLIPSE队列1749例中度至极重度COPD患者；CPRD数据库（与HES关联）27340例COPD患者。在CPRD数据库的模型开发、内部验证及外部验证中，主要结局为入组后两年内发生一次或多次呼吸系统入院；在ECLIPSE队列的外部验证中，主要结局为两年内发生严重急性加重。通过多元逻辑回归模型，从23个候选预测变量中开发模型，并采用自助法进行内部验证及对过拟合和乐观偏差进行校正。在每一阶段评估模型的区分度和校准度。与单一评分组件相比，在一系列临床相关风险阈值下检验评分的净获益（临床实用性）。在CPRD数据库中进行亚组分析和敏感性分析。在ECLIPSE队列中将BLISS评分与Bertens评分进行直接比较。与相关利益方探讨了临床实施的可行性。

BLISS评分保留了六个预测变量（年龄、COPD评估测试评分、过去12个月内的呼吸系统入院史、体重指数、糖尿病史、第一秒用力呼气容积占预计值百分比），用于评估个体两年内呼吸系统入院风险。该评分在内部验证（经乐观偏差校正的C统计量为0.73，95%置信区间0.70～0.77）和外部验证（ECLIPSE：C=0.73，0.71～0.76；CPRD：C=0.71，0.70～0.72）中均表现出相似的区分性能，并在BLISS（校准斜率=0.87，95%CI 0.73～1.02）、CPRD（0.89，0.85～0.93）和ECLIPSE（0.92，0.79～1.05）队列中展现出良好的校准度。在CPRD队列中的分层分析表明，该评分在不同人群亚组中均具有稳健性。净获益分析显示，BLISS评分优于单一预测因子及Bertens评分（C=0.68，0.65～0.71；校准斜率=0.68，0.56～0.81）。

研究结果表明，BLISS评分在评估来自不同背景、地域及疾病严重程度的COPD患者队列中，其个体两年内呼吸系统入院风险方面表现出良好性能。六个纳入变量中，有四个可便捷地从基层医疗记录中获取，另有两个虽部分可得但易于收集。未来需进行影响评估以全面研究该评分在临床诊疗中的应用价值。

附：英文原文

Title: Prognostic score for predicting respiratory admissions among patients with chronic obstructive pulmonary disease in primary care: development and validation in population cohorts (Birmingham Lung Improvement Studies (BLISS))

Author: Rachel E Jordan, Spencer J Keene, Frits M E Franssen, David Fitzmaurice, Nicola J Adderley, Andrew P Dickens, James T Martin, Alice J Sitch, Alexandra Enocson, Sue Jowett, Richard D Riley, Martin R Miller, Brendan G Cooper, Alice Turner, Kate Jolly, Jon G Ayres, Robert Stockley, Sheila Greenfield, Stanley Siebert, Amanda Daley, K K Cheng, Frank de Vries, Emiel F M Wouters, Peymane Adab

Issue&Volume: 2026/03/05

Abstract:

Objective To predict the two year risk of respiratory admission to hospital among individuals with chronic obstructive pulmonary disease (COPD), with the development and validation (internal and external) of a prognostic score.

Design Model development and validation in population cohorts.

Setting Birmingham Lung Improvement Studies (BLISS) cohort of new and existing patients with COPD in primary care (model development and internal validation); Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) international cohort and UK primary care Clinical Practice Research Datalink (CPRD) Aurum database linked with Hospital Episode Statistics (external validation).

Participants 1894 patients with new and existing COPD from BLISS cohort; 1749 patients with moderate to very severe COPD from ECLIPSE cohort; 27340 patients with COPD from CPRD Aurum database linked with Hospital Episode Statistics.

Main outcome measures One or more respiratory admissions within two years of cohort entry for development, internal validation, and external validation in CPRD; severe exacerbation within two years for external validation in ECLIPSE cohort. The model was developed from 23 candidate predictors by using multivariable logistic regression with bootstrapping for internal validation and adjustment for overfitting and optimism. Discrimination and calibration were assessed at each stage. Net benefit of the score (clinical utility) was examined across a range clinically relevant risk thresholds compared with use of individual score components. Subgroup and sensitivity analyses were conducted in the CPRD. The BLISS score was directly compared with the Bertens’ score in the ECLIPSE cohort. Clinical implementation was explored with relevant stakeholders.

Results Six predictors were retained (age, COPD Assessment Test score, respiratory admissions in the previous 12 months, body mass index, diabetes, forced expiratory volume in 1 second % predicted) to form the BLISS score for estimating an individual’s two year risk of respiratory admission. The score had similar discrimination performance on internal validation (optimism adjusted C statistic 0.73 (95% confidence interval 0.70 to 0.77)) and external validation (ECLIPSE: C=0.73 (0.71 to 0.76); CPRD: C=0.71 (0.70 to 0.72)) and good calibration performance in the BLISS (slope=0.87 (95% confidence interval 0.73 to 1.02), CPRD (0.89 (0.85 to 0.93)), and ECLIPSE (0.92 (0.79 to 1.05) cohorts). Stratified analysis in the CPRD cohort showed that it was robust in different population subgroups. Net benefit analyses showed superiority of the BLISS score over individual predictors and the Bertens’ score (C=0.68 (0.65 to 0.71); calibration slope 0.68 (0.56 to 0.81)).

Conclusions The BLISS score showed good performance in estimating individual risk of respiratory admission (within two years) in cohorts containing patients from different settings and geographical locations and with different severities of COPD. Four of the included six variables are readily available in primary care records, and two are partially available but easy to collect. Impact evaluations are now needed to fully study use of the score in clinical care.

DOI: 10.1136/bmj-2025-084521

Source: https://www.bmj.com/content/392/bmj-2025-084521