Robles-Hernández Robinson, Centeno-Saenz Gustavo I, Ramírez-Venegas Alejandra, Thirion-Romero Ireri, Hernández-Zenteno Rafael, Guinto-Ramírez Sandra P, Maya-García María C, Villegas-Trejo Diana, Montiel-López Francisco, Cordero-Silis Lila M, Pérez-Padilla Rogelio
Department of Smoking and COPD Research, National Institute of Respiratory Diseases, Mexico City, Mexico.
Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico.
ERJ Open Res. 2025 Jan 27;11(1). doi: 10.1183/23120541.00333-2024. eCollection 2025 Jan.
COPD ranks as the third leading global cause of mortality. Despite the widespread use of the BODE index and its variants for mortality prediction, their accuracy may be affected by factors like ethnicity, altitude and regional disparities. This study aimed to assess a new altitude-adapted prognostic index in COPD patients at moderate altitudes compared with the BODE and other mortality predictors.
We evaluated the performance of BODE and other standard prognostic indexes in an exploratory cohort of COPD patients using Cox proportional hazards models. Additionally, we developed a new risk-weighted prognostics model. We assessed its performance utilising receiver operating characteristic curves and compared it with BODE index variants. The indices were validated in a second cohort. The mean follow-up period in both cohorts was 7 years.
In the exploratory cohort (n=416), COPD patients had a 77% 5-year survival rate. eBODE exhibited superior predictive capacity (HR 1.22, 95% CI 1.11-1.34, p<0.05). Prognostic models included oxygen saturation measured by pulse oximetry <90%, body mass index, 6-min walk test (6MWT) and current smoking as primary relevant risks (BOSEA-90), with the second model excluding 6MWT (BOSA-90). BOSEA-90 predicted a major risk per point (HR 1.41, 95% CI 1.31-1.51, p<0.001) and superior discrimination (area under the curve (AUC) >0.75) compared to other indices (AUC <0.70, p<0.001). The validation cohort (n=436) confirmed effectiveness in differentiating mild and very severe cases.
The BODE prognostic index and its variants effectively predicted mortality, and the newly proposed BOSEA-90 and BOSA-90 indices demonstrated appropriate performance for a group of COPD patients at moderate altitude.
慢性阻塞性肺疾病（COPD）是全球第三大主要死因。尽管广泛使用BODE指数及其变体来预测死亡率，但其准确性可能受到种族、海拔和地区差异等因素的影响。本研究旨在评估一种新的适用于中度海拔COPD患者的海拔适应性预后指数，并与BODE指数及其他死亡率预测指标进行比较。
我们使用Cox比例风险模型在一个COPD患者的探索性队列中评估了BODE指数和其他标准预后指标的性能。此外，我们开发了一种新的风险加权预后模型。我们利用受试者工作特征曲线评估其性能，并将其与BODE指数变体进行比较。这些指数在第二个队列中得到验证。两个队列的平均随访期均为7年。
在探索性队列（n = 416）中，COPD患者的5年生存率为77%。eBODE表现出卓越的预测能力（风险比1.22，95%置信区间1.11 - 1.34，p < 0.05）。预后模型将经脉搏血氧饱和度测定的氧饱和度<90%、体重指数、6分钟步行试验（6MWT）和当前吸烟作为主要相关风险因素（BOSEA - 90），第二个模型排除了6MWT（BOSA - 90）。与其他指标相比（曲线下面积（AUC）< 0.70，p < 0.001），BOSEA - 90每增加一分预测主要风险（风险比1.41，95%置信区间1.31 - 1.51，p < 0.001）且具有更好的区分度（AUC > 0.75）。验证队列（n = 436）证实了其在区分轻度和极重度病例方面的有效性。
BODE预后指数及其变体有效预测了死亡率，新提出的BOSEA - 90和BOSA - 90指数在一组中度海拔的COPD患者中表现出了适当的性能。
