BODE-Index vs HADO-Score in Chronic Obstructive Pulmonary Disease: Which one to use in general practice?

Abstract

BackgroundForced expiratory volume in one second (FEV1) is used to diagnose and establish a prognosis in chronic obstructive pulmonary disease (COPD). Using multi-dimensional scores improves this predictive capacity.Two instruments, the BODE-index (Body mass index, Obstruction, Dyspnea, Exercise capacity) and the HADO-score (Health, Activity, Dyspnea, Obstruction), were compared in the prediction of mortality among COPD patients.MethodsThis is a prospective longitudinal study. During one year (2003 to 2004), 543 consecutively COPD patients were recruited in five outpatient clinics and followed for three years. The endpoints were all-causes and respiratory mortality.ResultsIn the multivariate analysis of patients with FEV1 < 50%, no significant differences were observed in all-cause or respiratory mortality across HADO categories, while significant differences were observed between patients with a lower BODE (less severe disease) and those with a higher BODE (greater severity). Among patients with FEV1 ≥ 50%, statistically significant differences were observed across HADO categories for all-cause and respiratory mortality, while differences were observed across BODE categories only in all-cause mortality.ConclusionsHADO-score and BODE-index were good predictors of all-cause and respiratory mortality in the entire cohort. In patients with severe COPD (FEV1 < 50%) the BODE index was a better predictor of mortality whereas in patients with mild or moderate COPD (FEV1 ≥ 50%), the HADO-score was as good a predictor of respiratory mortality as the BODE-index. These differences suggest that the HADO-score and BODE-index could be used for different patient populations and at different healthcare levels, but can be used complementarily.

Chronic obstructive pulmonary disease prognostic score: A new index

“…Furthermore exercise capacity tests are risky as they can cause hypoxia. Therefore, most of the recently devised COPD prognostic scales do not include an exercise capacity test [5][6][7][8][9] .…”

“…5,16 ). Among many dyspnea scales, the mMRC is commonly used for COPD prognostic scales and for daily practice [4][5][6][7][8][9][10][11] . The advantage of the mMRC over other dyspnea scales is its simplicity and the use of solid intervals between scores 18 .…”

“…The orthodox method of building a prognostic scale consists of two steps: the development of a scale using an initial cohort, and the validation of the scale using another patient cohort [4][5][6][7][8][9][10][11] . As the impact of each component varied greatly across studies, probably due to background patient characteristics [4][5][6][7][8][9][10][11] depending on a single development cohort is potentially risky. Furthermore, we can access extensive knowledge about life prognostic factors for COPD from previous studies , which were discussed.…”

“…General health condition: General health condition is a component of the HADO score 6,7 . Although we agreed that the general health condition is an indicator of death, we did not include this factor in our scale because reconstruction has not been sufficiently demonstrated for this score.…”

“…These scales are based on the following measurements: body mass index (BMI), airflow obstruction, dyspnea, and exercise capacity index (BODE index); age, dyspnea and the airway obstruction index (ADO index); the health, activity, dyspnea, and obstruction score; the Briggs prognostic index; a classification and regression tree; and the incremental shuttle walking test, BMI, airflow obstruction, dyspnea, and exercise capacity index [4][5][6][7][8][9][10][11] . These scales allow us to evaluate the systemic presentation of COPD.…”