ACCEPT 3.0: Recalibrating ACute COPD Exacerbation Prediction Tool (ACCEPT) for global use.
15 affiliations
- 1Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada. [email protected].
- 2Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. [email protected].
- 3BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. [email protected].
- 4Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada.
- 5Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
- 6Department of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
- 7Université Paris Cité, Institut Cochin, Inserm U1016, Paris, France.
- 8Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, 94304, USA.
- 9Respiratory Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
- 10Respiratory Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, USA.
- 11Global Medical Affairs - Respiratory, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
- 12Center 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.
- 13UBC Centre for Heart Lung Innovation (HLI), St. Paul's Hospital, Vancouver, BC, Canada.
- 14Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.
- 15Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Abstract
Background
The 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
Our 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
The 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
Recalibrating 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.
Related
- Initial proton pump inhibitor choice and 6-hour heartburn severity in acute reflux exacerbation: a prospective two-centre cohort study
- Quantitative CT-derived small pulmonary vessel and erector spinae muscle parameters associated with acute exacerbation in COPD patients from a cold region: a dual-center study
- Mechanistic insights into TLR2-mediated acute pancreatitis exacerbation via macrophage-ferroptotic acinar cell crosstalk
- Acute Exacerbation of Pre-existing Cancer-Related Pain: An Atypical Presentation of an Amivantamab-Induced Infusion-Related Reaction
- Metabolomic profiling reveals candidate discriminatory metabolites in stable chronic obstructive pulmonary disease and acute exacerbation
BibTeX
@article{lim2026accept,
title = {{ACCEPT 3.0: Recalibrating ACute COPD Exacerbation Prediction Tool (ACCEPT) for global use.}},
author = {Laura Huey Mien Lim and Jeenat Mehareen and Amin Adibi and Christer Janson and Pierre-Régis Burgel and Tae Yoon Lee and Hana Müllerová and Della Varghese and Jonathan Marshall and Surya P Bhatt and Don Sin and Wenjia Chen and Mohsen Sadatsafavi and NOVELTY Scientific Community and NOVELTY study investigators},
journal = {Diagnostic and prognostic research},
year = {2026},
month = oct,
doi = {10.1186/s41512-026-00242-x},
url = {https://europepmc.org/article/MED/42850639},
note = {CC BY},
}
RIS
TY - JOUR
TI - ACCEPT 3.0: Recalibrating ACute COPD Exacerbation Prediction Tool (ACCEPT) for global use.
AU - Laura Huey Mien Lim
AU - Jeenat Mehareen
AU - Amin Adibi
AU - Christer Janson
AU - Pierre-Régis Burgel
AU - Tae Yoon Lee
AU - Hana Müllerová
AU - Della Varghese
AU - Jonathan Marshall
AU - Surya P Bhatt
AU - Don Sin
AU - Wenjia Chen
AU - Mohsen Sadatsafavi
AU - NOVELTY Scientific Community and NOVELTY study investigators
PY - 2026
DA - 2026/10/08
JO - Diagnostic and prognostic research
DO - 10.1186/s41512-026-00242-x
UR - https://europepmc.org/article/MED/42850639
AB - Background The 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 Our 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 The 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 Recalibrating 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.
SN - 2397-7523
ER -