ACCEPT 3.0: Recalibrating ACute COPD Exacerbation Prediction Tool (ACCEPT) for global use.

Authors

Laura Huey Mien Lim, Jeenat Mehareen, Amin Adibi, Christer Janson, Pierre-Régis Burgel, Tae Yoon Lee, Hana Müllerová, Della Varghese, Jonathan Marshall, Surya P Bhatt, Don Sin, Wenjia Chen, Mohsen Sadatsafavi, NOVELTY Scientific Community and NOVELTY study investigators

Published in

Diagnostic and prognostic research. Volume 10. Issue 1. Oct 08, 2026. Epub Oct 08, 2026.

Abstract

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).
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.
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%.
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.

PMID:
42850639
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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