Imfeld Stephan, Bloch Konrad E, Weder Walter, Russi Erich W
Pulmonary Division, University Hospital, Raemistr. 100, CH-8091 Zürich, Switzerland.
Chest. 2006 Apr;129(4):873-8. doi: 10.1378/chest.129.4.873.
A recently introduced, multidimensional index called BODE (body mass index [BMI], degree of airflow obstruction assessed by spirometry, grade of dyspnea, and exercise capacity), quantified by 6-min walking distance (6MWD), has excellent predictive power with respect to outcome in COPD. We investigated whether the BODE index is able to predict survival after lung volume reduction surgery (LVRS).
Retrospective study.
Tertiary university hospital.
One hundred eight-six COPD patients (76 women) with severe emphysema (mean +/- SD age, 64 +/- 8 years; mean FEV(1), 28 +/- 8% of predicted).
Bilateral thoracoscopic LVRS.
BMI, pulmonary function, 6MWD, and the modified Medical Research Council dyspnea score were assessed before and 3 months after LVRS, and the BODE index was calculated. The patients were followed up with respect to survival for a median time of 40 months (range, 3 to 116 months) after surgery. The mean BODE index decreased from 7.2 +/- 1.6 preoperatively to 4.0 +/- 2.0 at 3 months after LVRS (p < 0.001). The postoperative but not the preoperative BODE correlated with survival, although preoperative patient characteristics were comparable between short-term (< 5 years) and long-term (> 5 years) survivors. A decrease to a lower BODE score class was associated with a reduced mortality (hazard ratio, 0.497, 95% confidence interval, 0.375 to 0.659; p < 0.001). The C statistic for the ability of the BODE index to predict the risk of death was larger (0.74) than that for the FEV(1) (0.63), the degree of dyspnea (0.64), or the 6MWD (0.62).
The postoperative BODE index is a powerful predictor of survival in COPD patients after LVRS.
一种最近引入的名为BODE（体重指数[BMI]、通过肺量计评估的气流阻塞程度、呼吸困难分级和运动能力）的多维指标，通过6分钟步行距离（6MWD）进行量化，在慢性阻塞性肺疾病（COPD）的预后方面具有出色的预测能力。我们研究了BODE指数是否能够预测肺减容手术（LVRS）后的生存率。
回顾性研究。
三级大学医院。
186例患有严重肺气肿的COPD患者（76名女性）（平均年龄±标准差，64±8岁；平均第1秒用力呼气容积[FEV(1)]，为预计值的28±8%）。
双侧胸腔镜LVRS。
在LVRS术前及术后3个月评估BMI、肺功能、6MWD和改良的医学研究委员会呼吸困难评分，并计算BODE指数。对患者术后生存情况进行随访，中位随访时间为40个月（范围3至116个月）。BODE指数均值从术前的7.2±1.6降至LVRS术后3个月时的4.0±2.0（p<0.001）。术后而非术前的BODE指数与生存率相关，尽管短期（<5年）和长期（>5年）生存者术前的患者特征具有可比性。BODE评分降至更低等级与死亡率降低相关（风险比，0.497，95%置信区间，0.375至0.659；p<0.001）。BODE指数预测死亡风险的C统计量（0.74）大于FEV(1)（0.63）、呼吸困难程度（0.64）或6MWD（0.62）的C统计量。
术后BODE指数是COPD患者LVRS术后生存率的有力预测指标。
