title: Predictive properties of different multidimensional staging systems in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is considered to be a respiratory disease with systemic manifestations. Some multidimensional staging systems, not based solely on the level of airflow limitation, have been developed; however, these systems have rarely been compared.
  
  
  METHODS
  We previously recruited 150 male outpatients with COPD for an analysis of factors related to mortality. For this report, we examined the discriminative and prognostic predictive properties of three COPD multidimensional measurements. These indices were the modified BODE (mBODE), which includes body mass index, airflow obstruction, dyspnea, and exercise capacity; the ADO, composed of age, dyspnea, and airflow obstruction; and the modified DOSE (mDOSE), comprising dyspnea, airflow obstruction, smoking status, and exacerbation frequency.
  
  
  RESULTS
  Among these indices, the frequency distribution of the mBODE index was the most widely and normally distributed. Univariate Cox proportional hazards analyses revealed that the scores on three indices were significantly predictive of 5-year mortality of COPD (P < 0.001). The scores on the mBODE and ADO indices were more significantly predictive of mortality than forced expiratory volume in 1 second, the Medical Research Council dyspnea score, and the St. George's Respiratory Questionnaire total score. However, peak oxygen uptake on progressive cycle ergometry was more significantly related to mortality than the scores on the three indices (P < 0.0001).
  
  
  CONCLUSIONS
  The multidimensional staging systems using the mBODE, ADO, and mDOSE indices were significant predictors of mortality in COPD patients, although exercise capacity had a more significant relationship with mortality than those indices. The mBODE index was superior to the others for its discriminative property. Further discussion of the definition of disease severity is necessary to promote concrete multidimensional staging systems as a new disease severity index in guidelines for the management of COPD.
authors: Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. ogato@kuhp.kyoto-u.ac.jp
authors: Toru
authors: T
authors: Oga
authors: Mitsuhiro
authors: M
authors: Tsukino
authors: Takashi
authors: T
authors: Hajiro
authors: Akihiko
authors: A
authors: Ikeda
authors: Koichi
authors: K
authors: Nishimura
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D016002:Discriminant Analysis; D004417:Dyspnea / Q000209:etiology; D005080:Exercise Test; D017079:Exercise Tolerance; D006305:Health Status Indicators; D006801:Humans; D007564:Japan; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012044:Regression Analysis; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors