Martinez Fernando J, Han Meilan K, Andrei Adin-Cristian, Wise Robert, Murray Susan, Curtis Jeffrey L, Sternberg Alice, Criner Gerard, Gay Steven E, Reilly John, Make Barry, Ries Andrew L, Sciurba Frank, Weinmann Gail, Mosenifar Zab, DeCamp Malcolm, Fishman Alfred P, Celli Bartolome R
Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0360, USA.
Am J Respir Crit Care Med. 2008 Sep 1;178(5):491-9. doi: 10.1164/rccm.200709-1383OC. Epub 2008 Jun 5.
The predictive value of longitudinal change in BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index has received limited attention. We hypothesized that decrease in a modified BODE (mBODE) would predict survival in National Emphysema Treatment Trial (NETT) patients.
To determine how the mBODE score changes in patients with lung volume reduction surgery versus medical therapy and correlations with survival.
Clinical data were recorded using standardized instruments. The mBODE was calculated and patient-specific mBODE trajectories during 6, 12, and 24 months of follow-up were estimated using separate regressions for each patient. Patients were classified as having decreasing, stable, increasing, or missing mBODE based on their absolute change from baseline. The predictive ability of mBODE change on survival was assessed using multivariate Cox regression models. The index of concordance was used to directly compare the predictive ability of mBODE and its separate components.
The entire cohort (610 treated medically and 608 treated surgically) was characterized by severe airflow obstruction, moderate breathlessness, and increased mBODE at baseline. A wide distribution of change in mBODE was seen at follow-up. An increase in mBODE of more than 1 point was associated with increased mortality in surgically and medically treated patients. Surgically treated patients were less likely to experience death or an increase greater than 1 in mBODE. Indices of concordance showed that mBODE change predicted survival better than its separate components.
The mBODE demonstrates short- and intermediate-term responsiveness to intervention in severe chronic obstructive pulmonary disease. Increase in mBODE of more than 1 point from baseline to 6, 12, and 24 months of follow-up was predictive of subsequent mortality. Change in mBODE may prove a good surrogate measure of survival in therapeutic trials in severe chronic obstructive pulmonary disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00000606).
体重指数、气流阻塞、呼吸困难和运动能力（BODE）指数的纵向变化的预测价值受到的关注有限。我们假设改良的BODE（mBODE）指数降低可预测国家肺气肿治疗试验（NETT）患者的生存率。
确定接受肺减容手术与药物治疗的患者的mBODE评分如何变化以及与生存率的相关性。
使用标准化工具记录临床数据。计算mBODE指数，并通过对每位患者进行单独回归分析来估计随访6个月、12个月和24个月期间患者特异性的mBODE轨迹。根据患者相对于基线的绝对变化，将患者分为mBODE降低、稳定、升高或缺失组。使用多变量Cox回归模型评估mBODE变化对生存率的预测能力。一致性指数用于直接比较mBODE及其各个组成部分的预测能力。
整个队列（610例接受药物治疗和608例接受手术治疗）的特征为基线时严重气流阻塞、中度呼吸困难和mBODE升高。随访时mBODE变化分布广泛。mBODE升高超过1分与手术和药物治疗患者的死亡率增加相关。接受手术治疗的患者死亡或mBODE升高超过1分的可能性较小。一致性指数表明，mBODE变化比其各个组成部分更能预测生存率。
mBODE显示出对重度慢性阻塞性肺疾病干预的短期和中期反应性。从基线到随访6个月、12个月和24个月时mBODE升高超过1分可预测随后的死亡率。mBODE变化可能是重度慢性阻塞性肺疾病治疗试验中生存率的良好替代指标。临床试验已在www.clinicaltrials.gov注册（NCT 00000606）。
