Multicomponent indices to predict survival in COPD: the COCOMICS study

Marı́n, José Marı́a; Alfageme, Inmaculada; Almagro, Pere; Casanova, Ciro; Esteban, Cristóbal; Soler-Cataluña, Juan José; de-Torres, Juan P.; Martínez‐Camblor, Pablo; Miravitlles, Marc; Celli, Bartolomé R.; Soriano, Joan B.

doi:10.1183/09031936.00121012

Cited by 94 publications

(75 citation statements)

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“…Initially, forced expiratory volume in 1 s (FEV1) was the main factor used in mortality prognostication in COPD, but increasing recognition of the predictive power of systemic and perceptive variables prompted development of multidimensional risk assessment tools [2,3]. One well-validated multidimensional tool is the BODE (body mass, airflow obstruction, dyspnoea, exercise capacity) index, determined based on the body mass index, FEV1 % predicted, modified Medical Research Council (mMRC) dyspnoea grade, and 6-min walk distance (6MWD) [2].…”

Section: Introductionmentioning

confidence: 99%

Adrenomedullin refines mortality prediction by the BODE index in COPD: the “BODE-A” index

Stolz¹,

Κostikas²,

Blasi³

et al. 2013

Eur Respir J

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The BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index is wellvalidated for mortality prediction in chronic obstructive pulmonary disease (COPD). Concentrations of plasma pro-adrenomedullin, a surrogate for mature adrenomedullin, independently predicted 2-year mortality among inpatients with COPD exacerbation.We compared accuracy of initial pro-adrenomedullin level, BODE and BODE components, alone or combined, in predicting 1-year or 2-year all-cause mortality in a multicentre, multinational observational cohort with stable, moderate to very severe COPD.Pro-adrenomedullin was significantly associated (p,0.001) with 1-year mortality (4.7%) and 2-year mortality (7.8%) and comparably predictive to BODE regarding both (C statistics 0.691 versus 0.745 and 0.635 versus 0.679, respectively). Relative to using BODE alone, adding pro-adrenomedullin significantly improved 1-year and 2-year mortality prognostication (C statistics 0.750 and 0.818, respectively; both p,0.001). Pro-adrenomedullin plus BOD was more predictive than the original BODE including 6-min walk distance. In multivariable analysis, pro-adrenomedullin (likelihood ratio Chi-squared 13.0, p,0.001), body mass index (8.5, p50.004) and 6-min walk distance (7.5, p50.006) independently foretold 2-year survival, but modified Medical Research Council dyspnoea score (2.2, p50.14) and forced expiratory volume in 1 s % predicted (0.3, p50.60) did not.Pro-adrenomedullin plus BODE better predicts mortality in COPD patients than does BODE alone; proadrenomedullin may substitute for 6-min walk distance in BODE when 6-min walk testing is unavailable. @ERSpublications Pro-adrenomedullin improves BODE prediction of mortality in COPD patients and may substitute for 6-min walk distance http://ow.ly/qV5M3This article has supplementary material available from www.erj.ersjournals.com Clinical trial: This study is registered at www.controlled-trials.com with identifier number ISRCTN99586989.

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Section: Introductionmentioning

confidence: 99%

Adrenomedullin refines mortality prediction by the BODE index in COPD: the “BODE-A” index

Stolz¹,

Κostikas²,

Blasi³

et al. 2013

Eur Respir J

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“…Exacerbation frequency, health status and level of physical activity are also predictors of mortality [42]. Several composite indices of disease severity have been developed (table 4) [43][44][45][46][47][48][49][50]. Although the prognostic accuracy of each of these indices has been confirmed in separate studies, few studies have directly compared one index to another.…”

Section: Disease Severitymentioning

confidence: 99%

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

et al. 2015

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified.Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus.Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes. @ERSpublications ATS/ERS statement: which types of research will have the greatest future impact on patientcentred outcomes in COPD? http://ow.ly/I54Hb

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“…The BODE index, which comprises nutritional status assessed by body mass index (BMI), airflow obstruction (FEV1 % pred), dyspnoea (using the modified Medical Research Council (mMRC) scale) and exercise capacity (6-min walking distance (6MWD)), was developed 10 years ago as a predictor of all-cause and respiratory mortality [3]. The BODE index has been externally validated in many settings and remains one of the best multidimensional tools for predicting mortality in COPD patients [2]. Surprisingly, very little data are available on longitudinal evolution of the BODE index in cohorts of COPD patients.…”

mentioning

confidence: 99%

“…Although levels of FEV1 were often reported to predict mortality, the observation that other pulmonary and extrapulmonary variables also predicted mortality led to the development of various multidimensional indices to predict survival in COPD [2]. The BODE index, which comprises nutritional status assessed by body mass index (BMI), airflow obstruction (FEV1 % pred), dyspnoea (using the modified Medical Research Council (mMRC) scale) and exercise capacity (6-min walking distance (6MWD)), was developed 10 years ago as a predictor of all-cause and respiratory mortality [3].…”

mentioning

confidence: 99%

Monitoring disease progression in COPD patients: one step beyond!

Burgel

2014

Eur Respir J

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@ERSpublications Variability in BODE index in COPD can inform recommendations for follow-up http://ow.ly/rV1kPChronic obstructive pulmonary disease (COPD) is defined by persistent airflow limitation that is usually progressive [1], and its severity has long been classified using forced expiratory volume in 1 s (FEV1) % predicted. Although levels of FEV1 were often reported to predict mortality, the observation that other pulmonary and extrapulmonary variables also predicted mortality led to the development of various multidimensional indices to predict survival in COPD [2]. The BODE index, which comprises nutritional status assessed by body mass index (BMI), airflow obstruction (FEV1 % pred), dyspnoea (using the modified Medical Research Council (mMRC) scale) and exercise capacity (6-min walking distance (6MWD)), was developed 10 years ago as a predictor of all-cause and respiratory mortality [3]. The BODE index has been externally validated in many settings and remains one of the best multidimensional tools for predicting mortality in COPD patients [2]. Surprisingly, very little data are available on longitudinal evolution of the BODE index in cohorts of COPD patients.In this issue of the European Respiratory Journal, CASANOVA et al. [4] analysed longitudinal variability of the BODE index in a hospital-based cohort of (mostly male) COPD patients. The authors used an original methodology in which subjects were categorised on the basis of their pattern of variability in BODE index over 4 years or more. Interestingly, the authors found that obtaining data of variability of yearly BODE index over 2 years was sufficient to determine impact on mortality. Thus, CASANOVA et al. [4] found that stable worsening (yearly increase of o1 unit) in BODE index over 2 years was associated with poorer survival in a multivariate model including several predictors of mortality in COPD patients. When assessing the variability of individual components of the BODE index, the authors reported that a high intraindividual variability in FEV1 was found and only 10-20% (depending on the chosen threshold) had consistent decline in FEV1 over 2 years. Importantly, pattern of FEV1 variability was unrelated to mortality. Variability in BMI and mMRC over 2 years were rather low and were also unrelated to mortality [4]. Clinically significant BMI decline (defined by the authors as a yearly loss of 1 kg?m -2 ) was present in a small number of patients, and variations in BMI may only marginally affect the BODE index in which BMI is categorised in two groups (.21 and f21 kg?m -2 ). Dyspnoea is an important prognostic factor in COPD patients and its assessment with mMRC is recommended [1]. Because mMRC lacks sensitivity and is poorly responsive to intervention [5], it is not surprising that very few patients had consistent increase in mMRC over 2 years. However, CASANOVA et al. [4] found that a stable decrease in exercise capacity, measured by a yearly decline in 6MWD by more than 50 m, was a clear predictor of mortality [4]. Importantly, the stable ...

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Multicomponent indices to predict survival in COPD: the COCOMICS study

Cited by 94 publications

References 45 publications

Adrenomedullin refines mortality prediction by the BODE index in COPD: the “BODE-A” index

Adrenomedullin refines mortality prediction by the BODE index in COPD: the “BODE-A” index

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD

Monitoring disease progression in COPD patients: one step beyond!

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