Development and internal validation of the elderly COPD diagnostic score (ECDS): a multidimensional diagnostic tool for moderate-to-severe chronic obstructive pulmonary disease
Year: 2026
Type: article
Abstract: Background: Accurate diagnosis of chronic obstructive pulmonary disease (COPD) among elderly individuals (≥65 years) presents considerable clinical difficulties. Age-associated physiological alterations, frequent multimorbidity, and atypical symptom manifestations complicate the diagnostic process. The conventional fixed FEV₁/FVC threshold of <0.70 may not be optimally suited for this population. This study aimed to construct and validate a novel multidimensional diagnostic tool that integrates both clinical and functional parameters. Methods: = 326, January 2024-March 2025). Within the Derivation Cohort, we developed the Elderly COPD Diagnostic Score (ECDS) through multivariable logistic regression and established age-specific FEV₁/FVC diagnostic thresholds. The finalized ECDS formula and threshold values were subsequently applied to the Validation Cohort without modification. Diagnostic performance was evaluated using ROC-AUC analysis, sensitivity and specificity calculations, and decision curve analysis (DCA). Results: < 0.05). At the optimal cutoff of ≥2.8, sensitivity reached 96.4% with specificity of 93.2%. In the independent Validation Cohort, the ECDS maintained robust performance with an AUC of 0.968, sensitivity of 95.1%, and specificity of 90.8%. DCA confirmed superior net clinical benefit across relevant threshold probabilities compared to alternative diagnostic strategies. Age-stratified FEV₁/FVC cutoffs (e.g., <64.5% for age ≥80) proved more accurate than the fixed <70% threshold. Notably, diagnostic accuracy of standard FEV₁/FVC measurement significantly diminished among patients with high comorbidity burden (CCI ≥ 5). Conclusion: The Elderly COPD Diagnostic Score (ECDS), which synthesizes spirometric data, clinical parameters, and comorbidity information, demonstrated excellent and validated diagnostic accuracy for moderate-to-severe COPD in elderly patients, surpassing the performance of conventional FEV₁/FVC criteria. Implementation of age-specific spirometric thresholds further refines diagnostic precision. The ECDS represents a practical, superior tool for diagnosing COPD in the complex geriatric patient population. While the ECDS offers a superior diagnostic tool for moderate-to-severe COPD in older adults, its performance in mild disease requires further validation.
Source: Frontiers in Medicine
Authors: Junmin Li, Quanzhu Fu, Hui Xiao
Institutions: Hubei University of Medicine, Taihe Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7141074668