title: Performance of the BODE index in patients with α1-antitrypsin deficiency-related COPD.
abstract: The BODE (body mass index, airflow obstruction, dyspnoea and exercise capacity) index is used to decide on referral and transplantation of patients with chronic obstructive pulmonary disease (COPD). The BODE index has not been validated in patients with α1-antitrypsin deficiency, who account for 15% of COPD patients undergoing lung transplantation. We sought to validate the BODE index in α1-antitrypsin deficiency-related COPD. We assessed the prognostic value of the BODE index in 191 patients followed from 2006 to 2012 in a French prospective cohort of patients with α1-antitrypsin deficiency. 20 patients died during follow-up and 22 underwent lung transplantation. Survival (95% CI) was 93.0% (91.7-94.3%) at 3 years and 76.0% (72.9-79.1%) at 5 years. The 3-year survival was 97.4% (96.6-98.2%), 98.0% (96.7-99.3%), 87.7% (84.5-90.9%) and 75.3% (66.0-84.6%) for patients with BODE index 0-2, 3-4, 5-6 and 7-10, respectively. Survival discrimination of the BODE index was better than with both forced expiratory volume in 1 s and Global Initiative for Chronic Obstructive Lung Disease classification. Regarding calibration, expected survival by BODE index was noticeably lower than observed survival. The BODE index showed very good survival discrimination in patients with α1-antitrypsin deficiency-related COPD. Larger studies are needed to support its use to drive patient referral for lung transplantation.
authors: Service de Pneumologie B et Transplantation Pulmonaire, APHP, Paris INSERM U700, Université Paris Diderot-Paris 7, Paris gthabut@gmail.com.
authors: Gabriel
authors: G
authors: Thabut
authors: Service de Pneumologie, Hospices Civils de Lyon, Lyon INRA UMR754, Université Lyon 1, Lyon.
authors: Jean-François
authors: JF
authors: Mornex
authors: Clinique Universitaire de Pneumologie CHU Grenoble, Grenoble INSERM U1055, Université Grenoble Alpes, Grenoble.
authors: Christophe
authors: C
authors: Pison
authors: Unité de Soins Intensifs Respiratoires, CHU Rouen, Rouen UPRES EA 3830, Institut de Recherche et d'Innovation Biomédicale de l'Université de Rouen, Rouen.
authors: Antoine
authors: A
authors: Cuvelier
authors: Laboratoire de Biochimie et Biologie Moléculaire, Centre de Biologie Pathologie, CHRU de Lille, Lille Faculté de Pharmacie, Université de Lille Nord de France, Lille.
authors: Malika
authors: M
authors: Balduyck
authors: Service de Pneumologie, Hôpital Larrey, CHU Toulouse, Toulouse.
authors: Marie-Christine
authors: MC
authors: Pujazon
authors: Service de Pneumologie B et Transplantation Pulmonaire, APHP, Paris INSERM U700, Université Paris Diderot-Paris 7, Paris.
authors: Michel
authors: M
authors: Fournier
authors: INSERM U700, Université Paris Diderot-Paris 7, Paris Centre d'Investigation Clinique, Hôpital Bichat, APHP, Paris.
authors: Brahim
authors: B
authors: AitIlalne
authors: Centre d'Epidémiologie Clinique, Groupe Hospitalier Cochin - Hôtel Dieu, Paris Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, APHP, Paris INSERM U738, Université Paris Descartes-Paris 5, Paris, France.
authors: Raphaël
authors: R
authors: Porcher
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D002138:Calibration; D004646:Emphysema / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005602:France; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D012372:ROC Curve; D012720:Severity of Illness Index; D012984:Software; D016896:Treatment Outcome; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality