Eur Respir J. 2014 Feb;43(2):397-408. doi: 10.1183/09031936.00058713. Epub 2013 Jun 21.
The BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index is well-validated 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, p=0.004) and 6-min walk distance (7.5, p=0.006) independently foretold 2-year survival, but modified Medical Research Council dyspnoea score (2.2, p=0.14) and forced expiratory volume in 1 s % predicted (0.3, p=0.60) did not. Pro-adrenomedullin plus BODE better predicts mortality in COPD patients than does BODE alone; pro-adrenomedullin may substitute for 6-min walk distance in BODE when 6-min walk testing is unavailable.
BODE（体重指数、气流阻塞、呼吸困难、运动能力）指数在预测慢性阻塞性肺疾病（COPD）患者死亡率方面具有良好的验证效果。血浆前肾上腺髓质素浓度作为成熟肾上腺髓质素的替代物，可独立预测 COPD 加重住院患者 2 年死亡率。我们比较了初始前肾上腺髓质素水平、BODE 及 BODE 各组成部分单独或联合预测多中心、多国观察性队列中稳定、中重度 COPD 患者 1 年或 2 年全因死亡率的准确性。前肾上腺髓质素与 1 年死亡率（4.7%）和 2 年死亡率（7.8%）显著相关（p<0.001），且与 BODE 相比，在这两个方面的预测能力相当（C 统计量分别为 0.691 与 0.745 和 0.635 与 0.679）。与单独使用 BODE 相比，添加前肾上腺髓质素可显著改善 1 年和 2 年死亡率预测（C 统计量分别为 0.750 和 0.818，均 p<0.001）。前肾上腺髓质素加 BODE 比包含 6 分钟步行距离的原始 BODE 更具预测性。在多变量分析中，前肾上腺髓质素（似然比卡方 13.0，p<0.001）、体重指数（8.5，p=0.004）和 6 分钟步行距离（7.5，p=0.006）独立预测 2 年生存率，但改良的医学研究委员会呼吸困难评分（2.2，p=0.14）和 1 秒用力呼气量占预计值的百分比（0.3，p=0.60）则不然。与单独使用 BODE 相比，前肾上腺髓质素加 BODE 能更好地预测 COPD 患者的死亡率；当 6 分钟步行测试不可用时，前肾上腺髓质素可能替代 BODE 中的 6 分钟步行距离。
