Background The Laboratory-based Intermountain Validated Exacerbation (LIVE) Score is associated with mortality and chronic obstructive pulmonary disease (COPD) exacerbation risk across multiple health systems. However, whether the LIVE Score and its associated risk is a stable patient characteristic is unknown.
Methods We validated the LIVE Score in a fourth health system. Then we determined the LIVE Score stability in a retrospective cohort of 98 766 patients with COPD in four health systems where it was previously validated. We assessed whether LIVE Scores changed or remained the same over time. Stability was defined as a majority of surviving patients having the same LIVE Score 4 years later.
Results The LIVE Score separated patients into three LIVE Score risk groups of low, medium, and high mortality and LIVE Score stability. Mortality ranged from 6.2% for low-risk LIVE to 45.8% for high-risk LIVE (p<0.001). We found that low-risk LIVE groups were stable and high-risk LIVE groups were unstable. Low-risk LIVE group patients remained low risk, but few high-risk LIVE group patients remained high risk (79.0% high vs 48.1% medium vs 8.8% low, p<0.001 for all pairwise comparisons).
Conclusion The LIVE Score identifies three major clinically actionable cohorts: a stable low-risk LIVE group, an unstable high-risk LIVE group with high mortality rates, and a medium-risk LIVE group. These observations further our understanding of how existing data used to calculate the LIVE Score may target interventions across risk cohorts of patients with COPD in a health system.
- COPD exacerbations
- health economist
- clinical epidemiology
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Contributors All authors have made substantial contributions to the conception and design of the work, drafting and revisions of the manuscript for important intellectual content, final approval for publication and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. In addition, SR, SZ, RM and KAC have provided data acquisition. DSC, SR, SZ, KAC, VP, DPB, MA and RM have provided data analysis and interpretation.
Funding This work was funded, in part, by the Intermountain Foundation. MA and SZ were supported by a grant from the Flight Attendant Medical Research Institute.
Competing interests DPB has participated in sponsored research, which has yielded publications in various forms at Intermountain Healthcare with the following companies: AstraZeneca, GlaxoSmithKline, Zebra Medical, and Prolung. VP has consulted for Edifices/Round Glass related to the need for and methods to address respiratory inhaler technique training, contributes to an asthma quality of care study funded by Novartis, is a subject matter expert for Vizient, and is currently supported on an NIH NHLBI R03 award (R03HL144883). MA receives salary support from the Department of Veterans Affairs. RM and the analytic group at Kaiser Permanente Center for Health Research had financial support in part from the Intermountain Foundation for data acquisition and analysis but otherwise no conflict relevant to this manuscript. RM has participated in sponsored research in COPD funded by GlaxoSmithKline, Spiration Inc, and Novartis. He has funding from PCORI as co-PI to lead the COPD Foundation Patient-Powered Research Network (PPRN).
Patient consent for publication Not required.
Ethics approval Institutional Review Boards (IRBs) at Intermountain Healthcare (IRB: 1040370), the University of California San Francisco and the San Francisco Veterans Affairs Medical Center Research and Development Committee (IRB: 15–16660), the Kaiser Permanente Northwest Research Center (IRB: STUDY00000759), and the University of Chicago Medicine (IRB: 17–0332).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Data Sharing Requests: In order to protect patient privacy and comply with relevant regulations, identified data are unavailable. Requests for de-identified data from qualified researchers with appropriate ethics board approvals and relevant data use agreements will be processed by the Intermountain Office of Research, email@example.com.
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