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Development and validation of a predictive model of failed stepping-down of inhaled corticosteroids in adult asthmatics

机译：成人哮喘患者吸入皮质类固醇激素降压失败的预测模型的建立和验证

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Background: Asthma guidelines suggest stepping-down of inhaled corticosteroids (ICSs) when asthma is stable. Objective: To determine outcomes of stepping-down and prediction of outcome after stepping-down of ICSs in controlled adult asthma. Methods: We performed a retrospective study on 21–81 year-old hospital-based outpatients with asthma in Japan. Protocol for stepping-down of ICSs was performed according to the GINA guideline. Failure/success of stepping-down is judged as occurring exacerbation or not for stepping-down of ICSs. Multiple logistic regression analysis was used to develop a prediction model for failed stepping-down, and then was validated by the leave-one-out cross-validation method. Our model of prediction score was calculated using receiver-operating characteristic area under the curve (AUC) analysis. The Nelson–Aalen curve demonstrated time to failure of stepping-down of ICSs. Results: A total of 126 patients with asthma attempted the stepping-down of ICSs according to the guideline. Of patients with follow-up, 97 (77.0%) of stepping-down attempts were successful. Using multivariate logistic regression analysis, comorbidity with rhinitis/rhinosinusitis and phlegm grade were independent predictors of failed stepping-down of ICSs, with odds ratios of 3.8 (95% confidence interval, 1.04–13.3; P =0.04) and 1.3 (95% confidence interval, 1.01–11.5; P =0.04), respectively. These variables were then used to build a prediction score in terms of the prediction of failed stepping-down events. When the two variables were added to form the prediction score, the discriminative power of scores calculated by the prediction model using the AUC was 0.75 (range: 0.62–0.88) for na?ve prediction and 0.72 (range: 0.60–0.86) after cross-validation. In the time-to-failure models, cumulative hazard ratio of failed stepping-down have fixed 1?year after stepping-down. Conclusion: Our results suggest that comorbidity with rhinitis/rhinosinusitis and phlegm grade are imperative to predict failed stepping-down of ICSs in controlled patients with adult asthma.
机译：背景：哮喘指南建议在哮喘稳定后逐步降低吸入糖皮质激素（ICSs）的剂量。目的：确定控制型成人哮喘中降压的结果以及降压ICSs后的结果。方法：我们对日本21-81岁住院哮喘患者进行了回顾性研究。根据GINA指南执行了ICS降压协议。降级的失败/成功被判断为是ICS的降级是否发生了恶化。多元逻辑回归分析用于建立失败降落的预测模型，然后通过留一法交叉验证方法进行验证。我们的预测分数模型是使用曲线下的接收器操作特征区域（AUC）分析来计算的。尼尔森-阿伦曲线显示了ICS降压失败的时间。结果：根据指南，共有126例哮喘患者尝试了降级ICSs。在接受随访的患者中，有97例（77.0％）成功下台尝试。使用多元逻辑回归分析，鼻炎/鼻窦炎和痰的合并症是ICS降级失败的独立预测因素，优势比分别为3.8（95％置信区间，1.04-13.3; P = 0.04）和1.3（95％置信度）区间1.01-11.5; P = 0.04）。这些变量然后用于根据失败的降压事件的预测建立预测分数。当将两个变量相加以形成预测分数时，对于天真的预测，预测模型使用AUC计算出的分数的判别力为0.75（范围：0.62-0.88），交叉后为0.72（范围：0.60-0.86） -验证。在失效时间模型中，降级失败的累积危害比固定为降级后的1年。结论：我们的结果表明，鼻炎/鼻窦炎合并症和痰液分级对预测成人控制性哮喘患者ICSs降级失败至关重要。

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