Development of the Multidimensional Assessment in COPD (MAC) score for short- and medium-term prognosis in highly-complex COPD patients at high risk of acute exacerbation

<bold>Background:</bold> We hypothesized that the Cumulative Illness Rating Scale (CIRS) could effectively measure comorbidity burden in the COPD setting and, based on our previous analysis, developed a new CIRS-based score, the Multidimensional Assessment in COPD (MAC), for assessing both comorbidity burden and COPD severity. <bold>Methods:</bold> We enrolled 105 participants with a confirmed diagnosis of COPD and at high risk for AE-COPD. For MAC score development, comorbidity was measured using the CIRS severity index, while respiratory variables were calculated according to CODEx thresholds; to calculate the scores to be assigned, we developed a logistic regression model by calculating the beta coefficients and approximating them to the nearest unit value (see Figure 1). The primary outcome was a composite of moderate or severe AE-COPD within 52 weeks. Secondary outcomes were severe AE-COPD at 12 weeks and at 52 weeks; <bold>Results:</bold> All MAC score c-statistics showed better predictive performance for both primary outcome: MAC Score Area Under the Curve (AUC): 0.812 (0.731-0.892); DOSE Index: 0.694; CODEx Index: 0.742; Charlson Comorbidity Index: 0.630; COMCOLD Index: 0.659; simlar data for secondary outcomes (data not shown). <bold>Conclusions:</bold> the MAC score significantly improves the predictive performance on COPD outcomes compared to previously available scores. <bold>Support Statement:</bold> This study is supported by the Ministry of Health, Czech Republic - conceptual development of research organization (FNBr, 65269705).