Exacerbations in Adults with Asthma: A Systematic Review and External Validation of Prediction Models

Rik J.B. Loymans; Thomas P.A. Debray; Persijn J. Honkoop; Evelien H. Termeer; Jiska B. Snoeck-Stroband; Tjard R.J. Schermer; Willem J.J. Assendelft; Merel Timp; Kian Fan Chung; Ana R. Sousa; Jacob K. Sont; Peter J. Sterk; Helen K. Reddel; Gerben ter Riet; Jaap K. Sont

doi:https://doi.org/10.1016/j.jaip.2018.02.004

Exacerbations in Adults with Asthma: A Systematic Review and External Validation of Prediction Models

Rik J.B. Loymans, Thomas P.A. Debray, Persijn J. Honkoop, Evelien H. Termeer, Jiska B. Snoeck-Stroband, Tjard R.J. Schermer, Willem J.J. Assendelft, Merel Timp, Kian Fan Chung, Ana R. Sousa, Jacob K. Sont, Peter J. Sterk, Helen K. Reddel, Gerben ter Riet, Jaap K. Sont

Research output: Contribution to journal › Article › Academic › peer-review

42 Citations (Scopus)

Abstract

BACKGROUND: Several prediction models assessing future risk of exacerbations in adult patients with asthma have been published. Applicability of these models is uncertain because their predictive performance has often not been assessed beyond the population in which they were derived.

OBJECTIVE: This study aimed to identify and critically appraise prediction models for asthma exacerbations and validate them in 2 clinically distinct populations.

METHODS: PubMed and EMBASE were searched to April 2017 for reports describing adult asthma populations in which multivariable models were constructed to predict exacerbations during any time frame. After critical appraisal, the models' predictive performances were assessed in a primary and a secondary care population for author-defined exacerbations and for American Thoracic Society/European Respiratory Society-defined severe exacerbations.

RESULTS: We found 12 reports from which 24 prediction models were evaluated. Three predictors (previous health care utilization, symptoms, and spirometry values) were retained in most models. Assessment was hampered by suboptimal methodology and reporting, and by differences in exacerbation outcomes. Discrimination (area under the receiver-operating characteristic curve [c-statistic]) of models for author-defined exacerbations was better in the primary care population (mean, 0.71) than in the secondary care population (mean, 0.60) and similar (0.65 and 0.62, respectively) for American Thoracic Society/European Respiratory Society-defined severe exacerbations. Model calibration was generally poor, but consistent between the 2 populations.

CONCLUSIONS: The preservation of 3 predictors in models derived from variable populations and the fairly consistent predictive properties of most models in 2 distinct validation populations suggest the feasibility of a generalizable model predicting severe exacerbations. Nevertheless, improvement of the models is warranted because predictive performances are below the desired level.

Original language	English
Article number	e15
Pages (from-to)	1942-1952
Journal	The Journal of Allergy and Clinical Immunology: In Practice
Volume	6
Issue number	6
DOIs	https://doi.org/10.1016/j.jaip.2018.02.004
Publication status	Published - Nov 2018

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https://doi.org/10.1016/j.jaip.2018.02.004

Cite this

Loymans, R. J. B., Debray, T. P. A., Honkoop, P. J., Termeer, E. H., Snoeck-Stroband, J. B., Schermer, T. R. J., Assendelft, W. J. J., Timp, M., Chung, K. F., Sousa, A. R., Sont, J. K., Sterk, P. J., Reddel, H. K., ter Riet, G., & Sont, J. K. (2018). Exacerbations in Adults with Asthma: A Systematic Review and External Validation of Prediction Models. The Journal of Allergy and Clinical Immunology: In Practice, 6(6), 1942-1952. Article e15. https://doi.org/10.1016/j.jaip.2018.02.004

@article{4ed74da041e34116ab66eab4e9ccc817,

title = "Exacerbations in Adults with Asthma: A Systematic Review and External Validation of Prediction Models",

abstract = "BACKGROUND: Several prediction models assessing future risk of exacerbations in adult patients with asthma have been published. Applicability of these models is uncertain because their predictive performance has often not been assessed beyond the population in which they were derived.OBJECTIVE: This study aimed to identify and critically appraise prediction models for asthma exacerbations and validate them in 2 clinically distinct populations.METHODS: PubMed and EMBASE were searched to April 2017 for reports describing adult asthma populations in which multivariable models were constructed to predict exacerbations during any time frame. After critical appraisal, the models' predictive performances were assessed in a primary and a secondary care population for author-defined exacerbations and for American Thoracic Society/European Respiratory Society-defined severe exacerbations.RESULTS: We found 12 reports from which 24 prediction models were evaluated. Three predictors (previous health care utilization, symptoms, and spirometry values) were retained in most models. Assessment was hampered by suboptimal methodology and reporting, and by differences in exacerbation outcomes. Discrimination (area under the receiver-operating characteristic curve [c-statistic]) of models for author-defined exacerbations was better in the primary care population (mean, 0.71) than in the secondary care population (mean, 0.60) and similar (0.65 and 0.62, respectively) for American Thoracic Society/European Respiratory Society-defined severe exacerbations. Model calibration was generally poor, but consistent between the 2 populations.CONCLUSIONS: The preservation of 3 predictors in models derived from variable populations and the fairly consistent predictive properties of most models in 2 distinct validation populations suggest the feasibility of a generalizable model predicting severe exacerbations. Nevertheless, improvement of the models is warranted because predictive performances are below the desired level.",

author = "Loymans, {Rik J.B.} and Debray, {Thomas P.A.} and Honkoop, {Persijn J.} and Termeer, {Evelien H.} and Snoeck-Stroband, {Jiska B.} and Schermer, {Tjard R.J.} and Assendelft, {Willem J.J.} and Merel Timp and Chung, {Kian Fan} and Sousa, {Ana R.} and Sont, {Jacob K.} and Sterk, {Peter J.} and Reddel, {Helen K.} and {ter Riet}, Gerben and Sont, {Jaap K.}",

year = "2018",

month = nov,

doi = "https://doi.org/10.1016/j.jaip.2018.02.004",

language = "English",

volume = "6",

pages = "1942--1952",

journal = "The Journal of Allergy and Clinical Immunology: In Practice",

issn = "2213-2198",

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Loymans, RJB, Debray, TPA, Honkoop, PJ, Termeer, EH, Snoeck-Stroband, JB, Schermer, TRJ, Assendelft, WJJ, Timp, M, Chung, KF, Sousa, AR, Sont, JK, Sterk, PJ, Reddel, HK, ter Riet, G & Sont, JK 2018, 'Exacerbations in Adults with Asthma: A Systematic Review and External Validation of Prediction Models', The Journal of Allergy and Clinical Immunology: In Practice, vol. 6, no. 6, e15, pp. 1942-1952. https://doi.org/10.1016/j.jaip.2018.02.004

TY - JOUR

T1 - Exacerbations in Adults with Asthma: A Systematic Review and External Validation of Prediction Models

AU - Loymans, Rik J.B.

AU - Debray, Thomas P.A.

AU - Honkoop, Persijn J.

AU - Termeer, Evelien H.

AU - Snoeck-Stroband, Jiska B.

AU - Schermer, Tjard R.J.

AU - Assendelft, Willem J.J.

AU - Timp, Merel

AU - Chung, Kian Fan

AU - Sousa, Ana R.

AU - Sont, Jacob K.

AU - Sterk, Peter J.

AU - Reddel, Helen K.

AU - ter Riet, Gerben

AU - Sont, Jaap K.

PY - 2018/11

Y1 - 2018/11

N2 - BACKGROUND: Several prediction models assessing future risk of exacerbations in adult patients with asthma have been published. Applicability of these models is uncertain because their predictive performance has often not been assessed beyond the population in which they were derived.OBJECTIVE: This study aimed to identify and critically appraise prediction models for asthma exacerbations and validate them in 2 clinically distinct populations.METHODS: PubMed and EMBASE were searched to April 2017 for reports describing adult asthma populations in which multivariable models were constructed to predict exacerbations during any time frame. After critical appraisal, the models' predictive performances were assessed in a primary and a secondary care population for author-defined exacerbations and for American Thoracic Society/European Respiratory Society-defined severe exacerbations.RESULTS: We found 12 reports from which 24 prediction models were evaluated. Three predictors (previous health care utilization, symptoms, and spirometry values) were retained in most models. Assessment was hampered by suboptimal methodology and reporting, and by differences in exacerbation outcomes. Discrimination (area under the receiver-operating characteristic curve [c-statistic]) of models for author-defined exacerbations was better in the primary care population (mean, 0.71) than in the secondary care population (mean, 0.60) and similar (0.65 and 0.62, respectively) for American Thoracic Society/European Respiratory Society-defined severe exacerbations. Model calibration was generally poor, but consistent between the 2 populations.CONCLUSIONS: The preservation of 3 predictors in models derived from variable populations and the fairly consistent predictive properties of most models in 2 distinct validation populations suggest the feasibility of a generalizable model predicting severe exacerbations. Nevertheless, improvement of the models is warranted because predictive performances are below the desired level.

AB - BACKGROUND: Several prediction models assessing future risk of exacerbations in adult patients with asthma have been published. Applicability of these models is uncertain because their predictive performance has often not been assessed beyond the population in which they were derived.OBJECTIVE: This study aimed to identify and critically appraise prediction models for asthma exacerbations and validate them in 2 clinically distinct populations.METHODS: PubMed and EMBASE were searched to April 2017 for reports describing adult asthma populations in which multivariable models were constructed to predict exacerbations during any time frame. After critical appraisal, the models' predictive performances were assessed in a primary and a secondary care population for author-defined exacerbations and for American Thoracic Society/European Respiratory Society-defined severe exacerbations.RESULTS: We found 12 reports from which 24 prediction models were evaluated. Three predictors (previous health care utilization, symptoms, and spirometry values) were retained in most models. Assessment was hampered by suboptimal methodology and reporting, and by differences in exacerbation outcomes. Discrimination (area under the receiver-operating characteristic curve [c-statistic]) of models for author-defined exacerbations was better in the primary care population (mean, 0.71) than in the secondary care population (mean, 0.60) and similar (0.65 and 0.62, respectively) for American Thoracic Society/European Respiratory Society-defined severe exacerbations. Model calibration was generally poor, but consistent between the 2 populations.CONCLUSIONS: The preservation of 3 predictors in models derived from variable populations and the fairly consistent predictive properties of most models in 2 distinct validation populations suggest the feasibility of a generalizable model predicting severe exacerbations. Nevertheless, improvement of the models is warranted because predictive performances are below the desired level.

U2 - https://doi.org/10.1016/j.jaip.2018.02.004

DO - https://doi.org/10.1016/j.jaip.2018.02.004

M3 - Article

C2 - 29454163

SN - 2213-2198

VL - 6

SP - 1942

EP - 1952

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

IS - 6

M1 - e15

ER -