title: BODE index or geriatric multidimensional assessment for the prediction of very-long-term mortality in elderly patients with chronic obstructive pulmonary disease? a prospective cohort study.
abstract: BACKGROUND
  a multidimensional approach-the BODE index-has been proposed for prognostic purposes in chronic obstructive pulmonary disease (COPD) and theoretically seems to be well suited for elderly people, but there is a lack of data in this population, especially with respect to long-term survival. The objective of this study is to evaluate whether the BODE index can predict both long (5 years) and very-long (10 and 15 years)-term mortality in an unselected population of elderly people with COPD better than a set of variables commonly taken into account in a geriatric multidimensional assessment (MDA).
  
  
  METHODS
  : this was a multicentre, prospective, population study. We used data from the SaRA study, which included 563 elderly people with COPD whose vital status was ascertained for up to 15 years after enrolment. The discriminative capacity of the BODE index in predicting mortality was derived from Cox proportional hazard models including the components of the BODE index and compared with that of an alternative model based on MDA variables: age, gender, physical disability, cognitive function and mood status.
  
  
  RESULTS
  : at 5 years, the HRs for mortality were 1.04 (95% CI: 0.60-1.79), 1.88 (1.10-3.22) and 3.55 (2.15-5.86) for quartiles 2-4, respectively, compared with quartile 1 of the BODE index. The corresponding figures for 10-year mortality were 1.50 (1.01-2.24), 2.11 (1.39-3.20) and 3.903 (2.62-5.82), and for 15-year mortality were 1.68 (1.19-2.36), 2.08 (1.44-3.01) and 3.78 (2.64-5.41). Similar results were obtained using variables included in the usual MDA.
  
  
  CONCLUSIONS
  : Both the 'classic' MDA and the BODE index are comparably associated with mortality, even at very long term, in elderly people with COPD.
authors: Cattedra di Geriatria, Università Campus Biomedico, Via dei Compositori 128, Roma 00128, Italy Fondazione Alberto Sordi, Rome, Italy.
authors: Claudio
authors: C
authors: Pedone
authors: Chair of Geriatrics, Unit of Respiratory Pathophysiology, Università Campus Bio Medico, Via A. del Portillo 200, Rome 00128, Italy.
authors: Simone
authors: S
authors: Scarlata
authors: Osservatorio Epidemiologico del Lazio, Rome, Italy.
authors: Francesco
authors: F
authors: Forastiere
authors: Dipartimento di Medicina, Pneumologia, Endocrinologia, Fisiologia e Nutrizione Umana, Università di Palermo, Palermo, Italy.
authors: Vincenzo
authors: V
authors: Bellia
authors: Department of Geriatrics, University Campus Bio-Medico, Via dei Compositori 130, Rome 00128, Italy Fondazione 'S. Raffaele - Cittadella della Carità', Taranto, Italy.
authors: Raffaele
authors: R
authors: Antonelli Incalzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007558:Italy; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000503:physiopathology*; D012129:Respiratory Function Tests; D015996:Survival Rate
keywords: BODE index; COPD; mortality; multidimensional assessment; older people