Prediction of risk of COPD exacerbations by the BODE index.
OBJECTIVE
This study assesses the power of the BODE index, a multidimensional grading system that predicts mortality, to predict subsequent exacerbations in patients with COPD.


METHODS
Prospective cohort study.


METHODS
A total of 275 COPD patients were followed every 6 months up to 8 years (median of 5.1 years). Baseline clinical variables were recorded and the BODE index was calculated. We investigated the prognostic value of BODE quartiles (scores 0-2, 3-4, 5-6 and 7-10) for both the number and severity of exacerbations requiring ambulatory treatment, emergency room visit, or hospitalization.


RESULTS
The annual rate of COPD exacerbations was 1.95 (95% CI, 0.90-2.1). The mean time to a first exacerbation was inversely proportional to the worsening of the BODE quartiles (7.9 yrs, 5.7 yrs, 3.4 yrs and 1.3 yrs for BODE scores of 0-2, 3-4, 5-6 and 7-10, respectively). Similarly, the mean time to a first COPD emergency room visit was 6.7 yrs, 3.6 yrs, 2.0 yrs and 0.8 yrs for BODE quartiles (all p<0.05). Using ROC curves, the BODE index was a better predictor of exacerbation than the FEV(1) alone (p<0.01).


CONCLUSIONS
The BODE index is a better predictor of the number and severity of exacerbations in COPD than FEV(1) alone.
Marin
Jose M
JM
Hospital Miguel Servet, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain. jmmarint@unizar.es
Carrizo
Santiago J
SJ
Casanova
Ciro
C
Martinez-Camblor
Pablo
P
Soriano
Joan B
JB
Agusti
Alvar G N
AG
Celli
Bartolome R
BR
D000203:Activities of Daily Living; D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D004630:Emergencies; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors