Puhan Milo A, Garcia-Aymerich Judith, Frey Martin, ter Riet Gerben, Antó Josep M, Agustí Alvar G, Gómez Federico P, Rodríguez-Roisín Roberto, Moons Karel G M, Kessels Alphons G, Held Ulrike
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Lancet. 2009 Aug 29;374(9691):704-11. doi: 10.1016/S0140-6736(09)61301-5.
The BODE index (including body-mass index, airflow obstruction, dyspnoea, and exercise capacity) was an important contribution to the prognostic assessment of patients with chronic obstructive pulmonary disease (COPD). However, no study has assessed whether the risk of mortality predicted by the BODE index matches the observed mortality in different populations. We assessed the calibration of the BODE index, updated it to improve its calibration, and developed and validated a simplified index for use in primary-care settings.
We included 232 patients from the Swiss Barmelweid cohort with longstanding and severe COPD and 342 patients from the Spanish Phenotype and Course of COPD cohort study who had had their first hospital admission due to moderate-to-severe COPD. In both cohorts we compared the observed 3-year risk of all-cause mortality with the risk predicted by the BODE index. We then updated the BODE index and developed a simplified ADO index (including age, dyspnoea, and airflow obstruction) from the Swiss cohort, and validated both in the Spanish cohort.
Calibration of the BODE index was poor, with relative underprediction of 3-year risk of mortality by 36% in the Swiss cohort (median predicted risk 21.7% [IQR 12.7-31.7] vs 34.1% observed risk; p=0.013) and relative overprediction by 39% in the Spanish cohort (16.7% [12.7-31.7] vs 12.0%; p=0.035). The 3-year risk of mortality predicted by both the updated BODE (median 10.7% [8.1-13.8]) and ADO indices (11.8% [9.1-14.3]) matched the observed mortality in the Spanish cohort well (p=0.99 and p=0.98, respectively).
Both the updated BODE and ADO indices could lend support to the prognostic assessment of patients with COPD in specialised and primary-care settings. Such assessment enhances the targeting of treatments to individual patients.
Swiss National Science Foundation; Klinik Barmelweid; Fondo de Investigación Sanitaria Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca Mèdiques, Catalonia Government; Spanish Society of Pneumology and Thoracic Surgery; Catalan Foundation of Pneumology; Red RESPIRA; Red RCESP; Fondo de Investigación Sanitaria; Fondo de Investigación Sanitaria; Fundació La Marató de TV3; Novartis Farmacèutica, Spain.
BODE指数（包括体重指数、气流阻塞、呼吸困难和运动能力）对慢性阻塞性肺疾病（COPD）患者的预后评估有重要贡献。然而，尚无研究评估BODE指数预测的死亡风险是否与不同人群中观察到的死亡率相符。我们评估了BODE指数的校准情况，对其进行更新以改善校准，并开发并验证了一种适用于基层医疗环境的简化指数。
我们纳入了来自瑞士巴梅尔维德队列的232例患有长期重度COPD的患者，以及来自西班牙COPD表型与病程队列研究的342例因中重度COPD首次入院的患者。在这两个队列中，我们比较了观察到的全因死亡3年风险与BODE指数预测的风险。然后，我们更新了BODE指数，并从瑞士队列中开发了一种简化的ADO指数（包括年龄、呼吸困难和气流阻塞），并在西班牙队列中进行了验证。
BODE指数的校准情况较差，在瑞士队列中，3年死亡风险的相对预测不足为36%（预测风险中位数为21.7%[四分位间距12.7 - 31.7]，观察到的风险为34.1%；p = 0.013），在西班牙队列中相对预测过度为39%（16.7%[12.7 - 31.7]对12.0%；p = 0.035）。更新后的BODE指数（中位数10.7%[8.1 - 13.8]）和ADO指数（11.8%[9.1 - 14.3]）预测的3年死亡风险与西班牙队列中观察到的死亡率匹配良好（分别为p = 0.99和p = 0.98）。
更新后的BODE指数和ADO指数均可为专科和基层医疗环境中COPD患者的预后评估提供支持。这种评估有助于针对个体患者进行治疗。
瑞士国家科学基金会；巴梅尔维德诊所；西班牙卫生部卫生研究基金；加泰罗尼亚政府医疗技术评估与研究局；西班牙肺科与胸外科协会；加泰罗尼亚肺病基金会；RESPIRA网络；RCESP网络；卫生研究基金；卫生研究基金；TV3马拉松基金会；西班牙诺华制药公司。
