The modified BODE index: validation with mortality in COPD

Abstract

Peak oxygen uptake (V9O 2 ) remains the gold standard measurement of exercise capacity and has been associated with survival. A modified BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index replacing the 6-min walk distance (6MWD) with V9O 2 as % predicted (mBODE%) has been developed and found to have excellent correlation with the conventional BODE index.The objectives of the present study were to compare the ability of the conventional BODE and the mBODE% to predict mortality in 444 patients with chronic obstructive pulmonary disease (COPD) followed for a mean¡SD period of 71¡34 months. Anthropometrics, spirometry, lung volumes, comorbidity, cardiopulmonary cyclo-ergometry test and 6MWD were determined at entry.The mean BODE indices for the cohort were: BODE 4.1¡2 and mBODE% 5.5¡2. Both indices were significantly correlated with mortality. Logistic regression analysis with COPD survival as the dependent variable identified the BODE index, Charlson's and exercise capacity (in W) as variables associated with this outcome.In conclusion, the conventional BODE index, which uses the 6-min walk distance, predicts mortality in chronic obstructive pulmonary disease as well as the modified index using peak oxygen uptake. The results support the use of the simpler index, which includes the 6-min walk distance in the comprehensive evaluation of patients with chronic obstructive pulmonary disease.KEYWORDS: Chronic obstructive pulmonary disease, exercise capacity, mortality T he oxygen uptake measured at peak exercise (V9O 2 ) during incremental cardiopulmonary exercise testing (CPET) is considered to be the gold standard for the evaluation of exercise capacity. V9O 2 helps predict survival in patients undergoing lung resection [1, 2] and lung volume reduction surgery (LVRS) [3], and in patients with chronic obstructive pulmonary disease (COPD) [4] and heart failure [5]. The 6-min walk test (6MWT) is easy to perform and has been standardised [6], and also predicts mortality in COPD [7,8] and in pulmonary hypertension [9].The 6MWT is considered a submaximal test; however, CASAS et al. [10] have shown that patients with COPD walk at a pace close to their maximal exercise capacity while the V9O 2 measured at the end of an incremental protocol in COPD is not a true maximal oxygen uptake [11,12]. This indicates that the differences between tests in the patients with COPD may not be as large as otherwise suspected. There is a modest but significant correlation between V9O 2 and 6-min walking distance (6MWD) [13,14], implying that the tests are not equal; however, as it relates to the capacity to predict survival in COPD, the current authors have recently shown that the 6MWD is equal to, if not better than, V9O 2 at predicting this outcome [15].The BODE index, which incorporates measurements of nutrition (body mass index), airflow obstruction (forced expiratory volume in one second (FEV1)), dyspnoea (Modified Medical Research Council dyspnoea scale) and exercise capacity as measured by the 6MWD,...

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“…However, none of the primary test formats could reasonably be regarded as stressing purely "aerobic" mechanisms; their symptom-limited character also confers varying degrees of "anaerobiosis". Several indices of physiological response relate independently to major clinical outcomes such as survival and hospital admissions, thus allowing considerable improvement in prognostic stratification [1,[5][6][7][8][9][10][11][12].…”

Monografia Giovani FADOI: dalle evidenze alla pratica clinica

“…Al tempo stesso il suo utilizzo comporta un aumentato rischio di sanguinamento. 161 Per questi motivi tale trattamento andrebbe introdotto solo dopo aver considerato il rischio di sanguinamento e le comorbidità. Gli ACEinibitori non sono normalmente prescritti nei pazienti con CI stabile, 67 perchè il loro vantaggio è limitato ai casi di scompenso cardiaco, ipertensione arteriosa e infarto miocardico.…”

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“…По данным работ Nishimura et al (2012) выраженность одышки по шкале mMRC является достоверным прогностическим критери-ем пятилетней выживаемости больных ХОБЛ [35]. В исследовании Cote C. G , Pinto-Plata et al (2008) продемонстрирована зависимость между показате-лями летальности при ХОБЛ и переносимости фи-зической нагрузки, определяемой по расстоянию, пройденному пациентом во время теста с 6-минут-ной ходьбой [11].…”

“…В целом, показатели ОФВ 1 , как было показано в многочисленных исследованиях, не коррелируют со степенью выраженности одышки, а прогности-ческая оценка тяжести течения ХОБЛ с использо-ванием только этих двух показателей не точна [10,11,25,34,36,37]. Для более достоверного прогно-за предложены шкалы многокомпонентной оцен-ки тяжести состояния больных (шкала оценки тя-жести состояния больных ХОБЛ -BODE, индекс DOSE, индекс ADO).…”