{
  "abstract": "Background\n\nThe ACute COPD Exacerbation Prediction Tool (ACCEPT) is an algorithm for predicting 12-month risk of chronic obstructive pulmonary disease (COPD) exacerbations. To make it suitable for international use, we externally validated and recalibrated ACCEPT 2.0 to incorporate country-specific background exacerbation risk, using multi-country data from NOVELTY (a NOVEL observational longiTudinal studY).Methods\n\nOur study cohort included patients aged [Formula: see text]40 years with physician-diagnosed COPD and [Formula: see text]30 days of follow-up. We predicted the occurrence of any moderate-to-severe (primary endpoint) and severe (secondary) exacerbations at 12 months, using country-level random effects to account for between-country differences in background exacerbation risks unexplained by predictor effects. We assessed model performance via discrimination, calibration, and net benefit.Results\n\nThe analysis sample comprised 5,181 patients (59.4% male, mean age at baseline 66.5 years) from 18 countries, with a mean follow-up of 357 days. 12-month risks ranged between 0.11 and 0.46 (mean = 0.26) for moderate-to-severe and 0.03-0.21 (mean = 0.08) for severe exacerbations. Without country-level adjustment, ACCEPT 2.0's area under the receiver operating characteristic curve (AUROC) was 0.73 (95% CI 0.72-0.75) and 0.76 (95% CI 0.73-0.78) for moderate-to-severe and severe exacerbations, respectively. However, ACCEPT 2.0 consistently overpredicted risks (observed-to-expected [O/E] risk ratio = 0.57 [95% CI 0.54-0.60] and 0.51 [95% CI 0.46-0.56]). After country-level recalibration, ACCEPT 3.0 showed similar AUROCs (0.75 and 0.76) but substantially improved calibration (O/E ratios: 0.99 [95% CI 0.94-1.05] and 0.99 [95% CI 0.90-1.09]). The net benefit of ACCEPT 3.0 exceeded ACCEPT 2.0 across treatment thresholds of 5%-20%.Conclusion\n\nRecalibrating ACCEPT 2.0 with country-level effects significantly improved calibration of COPD exacerbation risks. The resulting ACCEPT 3.0 is expected to provide higher clinical utility across a range of treatment thresholds.",
  "abstract_shown": true,
  "affiliations": [
    "Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada. hmienlim@yahoo.com.",
    "Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. hmienlim@yahoo.com.",
    "BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. hmienlim@yahoo.com.",
    "Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada.",
    "Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.",
    "Department of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.",
    "Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France.",
    "Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, 94304, USA.",
    "Respiratory Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.",
    "Respiratory Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, USA.",
    "Global Medical Affairs - Respiratory, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.",
    "Center for Lung Analytics and Imaging Research, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, University of Alabama at Birmingham, Birmingham, AL, USA.",
    "UBC Centre for Heart Lung Innovation (HLI), St. Paul's Hospital, Vancouver, BC, Canada.",
    "Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.",
    "Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Laura Huey Mien Lim",
      "orcid": "0009-0005-5384-8632"
    },
    {
      "affs": [
        3
      ],
      "name": "Jeenat Mehareen"
    },
    {
      "affs": [
        3
      ],
      "name": "Amin Adibi"
    },
    {
      "affs": [
        4
      ],
      "name": "Christer Janson"
    },
    {
      "affs": [
        5,
        6
      ],
      "name": "Pierre-Régis Burgel"
    },
    {
      "affs": [
        7
      ],
      "name": "Tae Yoon Lee"
    },
    {
      "affs": [
        8
      ],
      "name": "Hana Müllerová"
    },
    {
      "affs": [
        9
      ],
      "name": "Della Varghese"
    },
    {
      "affs": [
        10
      ],
      "name": "Jonathan Marshall"
    },
    {
      "affs": [
        11
      ],
      "name": "Surya P Bhatt"
    },
    {
      "affs": [
        12,
        13
      ],
      "name": "Don Sin"
    },
    {
      "affs": [
        14
      ],
      "name": "Wenjia Chen"
    },
    {
      "affs": [
        3,
        12,
        13
      ],
      "name": "Mohsen Sadatsafavi"
    },
    {
      "name": "NOVELTY Scientific Community and NOVELTY study investigators"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/39x9pafjjm8qf.bib",
  "cited_by": 0,
  "doi": "10.1186/s41512-026-00242-x",
  "fulltext_url": "https://europepmc.org/articles/PMC13651374",
  "id": "39x9pafjjm8qf",
  "issns": [
    "2397-7523"
  ],
  "landing_url": "https://europepmc.org/article/MED/42850639",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Chronic Obstructive Pulmonary Disease (COPD) Research"
    ]
  ],
  "openalex": "W7220897664",
  "pdf_url": "https://europepmc.org/articles/PMC13651374?pdf=render",
  "pmcid": "PMC13651374",
  "pmid": "42850639",
  "published": "2026-10-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/39x9pafjjm8qf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:02Z",
      "native_id": "MED:42850639",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42850639"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Chronic Obstructive Pulmonary Disease (COPD) Research",
      "subfield": "general"
    }
  ],
  "title": "ACCEPT 3.0: Recalibrating ACute COPD Exacerbation Prediction Tool (ACCEPT) for global use.",
  "title_text": "ACCEPT 3.0: Recalibrating ACute COPD Exacerbation Prediction Tool (ACCEPT) for global use.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:02Z",
  "url": "https://research.draconitic.com/paper/39x9pafjjm8qf",
  "venue": "Diagnostic and prognostic research",
  "versions": []
}