title: Prognostic evaluation of COPD patients: GOLD 2011 versus BODE and the COPD comorbidity index COTE.
abstract: BACKGROUND
  The Global Obstructive Lung Disease (GOLD) 2011 revision recommends the multidimensional assessment of COPD including comorbidities and has developed a disease categories system (ABCD) attempting to implement this strategy. The added value provided by quantifying comorbidities and integrating them to multidimensional indices has not been explored.
  
  
  OBJECTIVE
  Compare the prognostic value of the GOLD ABCD categories versus the BMI, Obstruction, Dyspnea, Exercise (BODE) index, and explore the added prognostic value of comorbidities evaluation to this multidimensional assessment.
  
  
  METHODS
  From the patients who have been enrolled in the BODE study, we selected the most recent ones who had the available information needed to classify them by the ABCD GOLD categories. Cox proportional hazards ratios for all-cause mortality were performed for GOLD categories and BODE index. The added value of the comorbidity Copd cO-morbidity TEst (COTE) index was also explored using receiver operating curves (ROC) values.
  
  
  RESULTS
  707 patients were followed for 50±30 months including all degrees of airway limitation and BODE index severity. ABCD GOLD predicted global mortality (HR: 1.47; 95% CI 1.28 to 1.70) as did the BODE index (HR: 2.02; 95% CI 1.76 to 2.31). Area under the curve (AUC) of ROC for ABCD GOLD was 0.68; (95% CI 0.64 to 0.73) while for the BODE index was 0.71 (95% CI 0.67 to 0.76). The C statistics value was significantly higher for the observed difference. Adding the COTE index to the BODE index improved its AUC to 0.81 (95% CI 0.77 to 0.85), (χ(2)=40.28, p<0.001).
  
  
  CONCLUSIONS
  In this population of COPD patients, the BODE index had a better survival prediction than the ABCD GOLD categories. Adding the COTE to the BODE index was complimentary and significantly improved outcome prediction.
authors: Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors: Juan P
authors: JP
authors: de Torres
authors: Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain.
authors: Ciro
authors: C
authors: Casanova
authors: Pulmonary Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors: Jose M
authors: JM
authors: Marín
authors: Pulmonary Department, Hospital Universitario Dr Negrin, Las Palmas, Spain.
authors: Victor
authors: V
authors: Pinto-Plata
authors: Pulmonary Department, Hospital Universitario Dr Negrin, Las Palmas, Spain.
authors: Miguel
authors: M
authors: Divo
authors: Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors: Javier J
authors: JJ
authors: Zulueta
authors: Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors: Juan
authors: J
authors: Berto
authors: Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors: Jorge
authors: J
authors: Zagaceta
authors: Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors: Pablo
authors: P
authors: Sanchez-Salcedo
authors: Pulmonary Department, Hospital Universitario Dr Negrin, Las Palmas, Spain.
authors: Carlos
authors: C
authors: Cabrera
authors: Pulmonary Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors: Santiago
authors: S
authors: Carrizo
authors: Pulmonary Department, Bay Pines VA Medical Center, St Petersburg, Florida, USA.
authors: Claudia
authors: C
authors: Cote
authors: Pulmonary Department, Brigham and Women's Hospital. Harvard Medical School Boston, Boston Massachusetts, USA.
authors: Bartolome R
authors: BR
authors: Celli
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification* / Q000401:mortality / Q000503:physiopathology; D012372:ROC Curve; D012720:Severity of Illness Index
keywords: COPD Pathology