Evaluation of BODE index and its relationship with systemic inflammation mediated by proinflammatory biomarkers in patients with COPD

Abstract

IntroductionBODE index, a multidimensional grading system which is based on Body mass index, airway Obstruction, Dyspnea scale, and Exercise capacity, has been increasingly used for the evaluation of chronic obstructive pulmonary disease (COPD). Many of the systemic manifestations of COPD are shown to be mediated by elevated levels of proinflammatory biomarkers.ObjectiveWe aimed to investigate the relationship between the BODE index, its components, disease severity, and proinflammatory biomarkers like C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6.Materials and methodsA cross-sectional study which included 290 clinically stable COPD patients and 80 smoker controls was conducted. Medical history, body mass index, pulmonary function tests, 6-minute walking test, and modified scale of Medical Research Council dyspnea scale were evaluated. BODE scores were determined. Systemic inflammation was evaluated with the measurement of CRP, TNF-α, and IL-6 in the serum samples of all studied subjects. The correlation between inflammatory biomarkers and BODE index was assessed in COPD patients.ResultsWe found a significant relationship between COPD stages and BODE index. Our analysis showed significant association between systemic biomarkers and components of the BODE index. Both TNF-α and CRP levels exhibited weak but significant correlation with BODE index. Serum IL-6 concentrations exhibited significant correlation with 6-minute walking test, modified scale of Medical Research Council, and BODE index (r=0.201, P=0.004; r=0.068, P=0.001; and r=0.530, P=0.001, respectively). Also, an inverse and significant correlation was observed between BODE index and FEV1 (r=0.567, P=0.001). IL-6 exhibited a highly significant and inverse correlation with FEV1 (r=−0.580, P=0.001).ConclusionBODE index should be considered for evaluating patients with COPD. Also, IL-6 seems to be a potential biomarker that may enable determination of the severity and prediction of the course of the disease.

<p>Benefits of different intensities of pulmonary rehabilitation for patients with moderate-to-severe COPD according to the GOLD stage: a prospective, multicenter, single-blinded, randomized, controlled trial</p>

“…Those results are in line with previously reported findings (eg, Moore et al6), demonstrating that PR can reduce hospital admissions for AECOPD. A number of researches25–27 also showed a significant relationship between GOLD stages and the BODE index, and the capacity of exercise in patients was associated with the severity of COPD. It was confirmed that geriatric COPD rehabilitation in the setting of a nursing home may reduce hospital admissions in frail COPD patients and increase exercise tolerance as well.…”

Association of energy and protein intakes with length of stay, readmission and mortality in hospitalised patients with chronic obstructive pulmonary disease

“…Most of our subjects were hospitalised owing to an acute exacerbation, and this may have interfered with their ability or desire to eat. In some patients, inflammation is associated with an increase in REE ( 37 ) , which, in the presence of poor dietary intake, may contribute to impaired energy balance ( 13 ) . Many studies now show, however, that although acutely unwell patients have an increase in REE this is more than compensated for by a decrease in physical activity.…”

Noninvasive Ventilation as an Important Adjunct to an Exercise Training Program in Subjects With Moderate to Severe COPD

“…In addition, more severely affected patients show more reduced respiratory and peripheral muscle strength and endurance, as well as more hypoxemia and symptoms of hyperinflation 4 during exercise than patients with mild COPD. 3,5 It is already widely accepted that physical training is an essential part of nonpharmacologic treatment in moderate to severe COPD and is considered a key point in pulmonary rehabilitation programs aimed at improving exercise capacity, reducing symptoms, and enhancing quality of life. 6,7 With physical training being widely recognized and accepted as a fundamental component of a rehabilitation process, exercise intensity is an important factor to considered to achieve satisfactory physiological gains and relevant clinical outcomes.…”