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Publications

Journal Article Review Ahead of print

PubMed: 41314222 DOI: 10.1016/S2213-2600(25)00362-5

Multidimensional prognostic risk stratification of COPD exacerbations: the baseline, acuity, and trigger (BAt) model.

Lancet Respir Med

Authors: Hnin W W Aung, Kristina Vermeersch, Hamish J C McAuley, Sanjay Ramakrishnan, Mustafa Abdo, Amber Beersaerts, Steven P Cass, Nicola Smallcombe, Iwein Gyselinck, Hendrik Pott, Tom J C Ward, Adam K A Wright, Christopher E Brightling, Pierre-RĂ©gis Burgel, Marco Contoli, Frits M E Franssen, Arturo Huerta, Jennifer K Quint, Bernd Schmeck, Lowie E G W Vanfleteren, Benjamin Waschki, Henrik Watz, Mona Bafadhel, Wim Janssens, Neil J Greening

Affiliations

  • Institute for Lung Health, National Institute for Health and Care Research Leicester Biomedical Research Centre (Respiratory), Glenfield Hospital, Leicester, UK; School of Medical Sciences, Division of Respiratory Sciences, University of Leicester, Leicester, UK.
  • Research group BREATHE, KU Leuven, Leuven, Belgium.
  • Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; Institute for Respiratory Health, University of Western Australia, Perth, WA, Australia; University of Western Australia Medical School, Perth, WA, Australia.
  • LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; Internal Medicine Department, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany.
  • King's Centre for Lung Health, School of Immunology and Microbial Sciences, King's College London, London, UK.
  • Department of Respiratory Diseases, UZ Leuven, Leuven, Belgium.
  • Department of Medicine, Pulmonary, and Critical Care Medicine, Clinic for Airway Infections, University Medical Centre Marburg, Philipps-University Marburg, Marburg, Germany; Institute for Lung Research, Universities of Giessen and Marburg Lung Center, DZL, Philipps-University Marburg, Marburg, Germany.
  • Department of Respiratory Medicine, Cochin Hospital, Assistance Publique HĂ´pitaux de Paris, Paris, France; UniversitĂ© Paris CitĂ©, Paris, France.
  • Azienda Ospedaliera Universitaria Ferrara and Azienda UnitĂ  Sanitaria Locale di Ferrara, Ferrara, Italy; Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
  • Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands.
  • Emergency Department, Pulmonary and Critical Care Division, ClĂ­nica Sagrada FamĂ­lia, Universitat Internacional De Catalunya, Barcelona, Spain.
  • School of Public Health, Imperial College London, London, UK.
  • Department of Respiratory Diseases, UZ Leuven, Leuven, Belgium; Institute for Lung Research, Universities of Giessen and Marburg Lung Center, DZL, Philipps-University Marburg, Marburg, Germany.
  • Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; Department of Pulmonary Medicine, Itzehoe Hospital, Itzehoe, Germany.
  • LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; Velocity Clinical Research Germany, Ahrensburg, Germany; University of LĂ¼beck, ARCN, DZL, LĂ¼beck, Germany.
  • Research group BREATHE, KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, UZ Leuven, Leuven, Belgium.
  • Institute for Lung Health, National Institute for Health and Care Research Leicester Biomedical Research Centre (Respiratory), Glenfield Hospital, Leicester, UK; School of Medical Sciences, Division of Respiratory Sciences, University of Leicester, Leicester, UK.

Abstract

Exacerbations punctuate the natural course of chronic obstructive pulmonary disease (COPD), posing a substantial burden on patients and health-care systems. Understanding the severity of an acute exacerbation of COPD (AECOPD) is crucial for stratifying mortality risk and guiding treatment decisions. Currently, the severity of an AECOPD is primarily graded on outcomes of health-care use. Given the complex heterogeneity in pathogenesis, clinical presentation, post-event trajectory, and patient perspectives, this approach does not adequately address the causes and extent of clinical deterioration or consider an individual's baseline status, upon which implementation of treatment and prevention of future exacerbations rely. We have conceptualised a multidimensional model to stratify the severity and prognostic risk of an AECOPD, incorporating three distinct domains: baseline functional status (B), the intensity of the event (acuity; A), and the causal trigger (t). The BAt classification for AECOPD could allow for more individualised prognostic and therapeutic implications. The validation process for this model is underway, with preliminary findings supporting its feasibility.

MeSH

Pulmonary Disease, Chronic Obstructive, Therapeutics