Development of a risk prediction model to predict the risk of hospitalization due to exacerbated asthma among adult asthma patients in a lower middle-income country

Abstract

Abstract Background: Asthma patients experience higher rates of hospitalizations due to exacerbations leaving a considerable clinical and economic burden on the healthcare system. The use of a simple, risk prediction tool offers a low-cost mechanism to identify these high-risk asthma patients for specialized care. The study aimed to develop and validate a risk prediction model to identify high-risk asthma patients for hospitalization due to exacerbations. Methods: Hospital-based, case-control study was carried out among 466 asthma patients aged ≥20 years recruited from four tertiary care hospitals in a district of Sri Lanka to identify risk factors for asthma-related hospitalizations. Patients (n=116) hospitalized due to an exacerbation with respiratory rate >30/min, pulse rate >120 bpm, O2 saturation (on air) < 90% on admission, selected consecutively from medical wards; controls (n=350;1:3 ratio) randomly selected from asthma/medical clinics. Data was collected via a pre-tested interviewer-administered questionnaire (IAQ). Logistic regression analyses were performed to develop the model with consensus from an expert panel. A second case-control study was carried out to assess the criterion validity of the new model recruiting 158 cases and 101 controls from the same hospitals. Data was collected using an IAQ based on the newly developed risk prediction model. Results: The developed model consisted of ten predictors with an area under the curve (AUC) of 0.83 (95% CI: 0.78 to 0.88, P<0.001), sensitivity 69.0%, specificity 86.1%, positive predictive value (PPV) 88.6%, negative predictive value (NPV) 63.9%. Positive and negative likelihood ratios were 4.9 and 0.3, respectively. Conclusions: The newly developedmodel was proven valid to identify adult asthma patients who are at risk of hospitalization due to exacerbations. It is recommended as a simple, low-cost tool for identifying and prioritizing high-risk asthma patients for specialized care.