目的:判断喉部症状是否由胃食管反流引起,在临床上具有挑战性,需要一种对患者进行分层的可靠工具。我们旨在开发和验证一个模型来预测慢性喉症状患者胃食管反流病(GERD)的可能性。
方法:这项多中心国际研究收集了在2018年3月5日至2023年3月5日期间接受客观测试(上消化道内窥镜检查和/或动态反流监测)的慢性喉症状成人的数据。训练阶段确定了具有最佳接收器工作特性曲线的模型,和β系数为加权模型提供了信息。验证阶段评估加权模型的性能特征。
结果:856名成年人,304在训练队列中,552在验证队列中,包括在内。在训练阶段,最佳预测模型[AUC0.68(95%CI0.62,0.74)]-COuGHReflux评分-包括咳嗽,超重/肥胖,Globus,食管裂孔疝,反流,和男性seX的下限阈值为2.5,上限阈值为5.0,以预测已证实的GERD。在验证阶段,COuGHReflux评分对已证实的GERD的AUC为0.67(0.62,0.71),敏感性为79%,特异性为81%.
结论:外部验证的COuGHRefluX评分是预测已证实GERD可能性的临床实用模型。该评分将大多数患有慢性喉部症状的患者分类为低/高可能性的GERD,只有38%是不确定的。因此,COuGHRefluX评分可以指导诊断策略,并减少被转诊用于慢性喉部症状评估的患者不适当使用质子泵抑制剂或进行检测.
OBJECTIVE: Discerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict the likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms.
METHODS: This multicenter international study collected data from adults with chronic laryngeal symptoms who underwent objective testing (upper gastrointestinal endoscopy and/or ambulatory reflux monitoring) between March 2018 and May 2023. The training phase identified a model with optimal receiver operating characteristic curves, and β coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model.
RESULTS: A total of 856 adults, 304 in the training cohort and 552 in the validation cohort, were included. In the training phase, the optimal predictive model (area under the curve, 0.68; 95% CI, 0.62-0.74), was the Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX) score, with a lower threshold of 2.5 and an upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62-0.71), with 79% sensitivity and 81% specificity for proven GERD.
CONCLUSIONS: The externally validated COuGH RefluX score is a clinically practical model to predict the likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. Thus, the COuGH RefluX score can guide diagnostic strategies and reduce inappropriate proton pump inhibitor use or testing for patients referred for evaluation of chronic laryngeal symptoms.