title: Differential Effect of Modified Medical Research Council Dyspnea, COPD Assessment Test, and Clinical COPD Questionnaire for Symptoms Evaluation Within the New GOLD Staging and Mortality in COPD.
abstract: OBJECTIVE
  The modified Medical Research Council (mMRC) dyspnea, the COPD Assessment Test (CAT), and the Clinical COPD Questionnaire (CCQ) have been interchangeably proposed by GOLD (Global Initiative for Chronic Obstructive Lung Disease) for assessing symptoms in patients with COPD. However, there are no data on the prognostic value of these tools in terms of mortality. We endeavored to evaluate the prognostic value of the CAT and CCQ scores and compare them with mMRC dyspnea.
  
  
  METHODS
  We analyzed the ability of these tests to predict mortality in an observational cohort of 768 patients with COPD (82% men; FEV1, 60%) from the COPD History Assessment in Spain (CHAIN) study, a multicenter observational Spanish cohort, who were monitored annually for a mean follow-up time of 38 months.
  
  
  RESULTS
  Subjects who died (n = 73; 9.5%) had higher CAT (14 vs 11, P = .022), CCQ (1.6 vs 1.3, P = .033), and mMRC dyspnea scores (2 vs 1, P < .001) than survivors. Receiver operating characteristic analysis showed that higher CAT, CCQ, and mMRC dyspnea scores were associated with higher mortality (area under the curve: 0.589, 0.588, and 0.649, respectively). CAT scores ≥ 17 and CCQ scores > 2.5 provided a similar sensitivity than mMRC dyspnea scores ≥ 2 to predict all-cause mortality.
  
  
  CONCLUSIONS
  The CAT and the CCQ have similar ability for predicting all-cause mortality in patients with COPD, but were inferior to mMRC dyspnea scores. We suggest new thresholds for CAT and CCQ scores based on mortality risk that could be useful for the new GOLD grading classification.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.
authors.affiliation: Pulmonary Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife. Electronic address: casanovaciro@gmail.com.
authors.forename: Ciro
authors.initials: C
authors.lastname: Casanova
authors.affiliation: Pulmonary Department, Hospital Universitario Miguel Servet, Zaragoza; Pulmonary Department, Hospital Universitario Germans Trias y Pujol, Badalona, Barcelona.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Marin
authors.affiliation: Pulmonary Department, Hospital Universitario Central de Asturias, Oviedo.
authors.forename: Cristina
authors.initials: C
authors.lastname: Martinez-Gonzalez
authors.affiliation: Pulmonary Department I, Hospital General Universitario Gregorio Marañón, Madrid.
authors.forename: Pilar
authors.initials: P
authors.lastname: de Lucas-Ramos
authors.affiliation: Pulmonary Department, Hospital Son Llátzer, Mallorca.
authors.forename: Isabel
authors.initials: I
authors.lastname: Mir-Viladrich
authors.affiliation: Pulmonary Department, Hospital Universitario Son Espases-IDISPA, Palma de Mallorca; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid.
authors.forename: Borja
authors.initials: B
authors.lastname: Cosio
authors.affiliation: CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid; Pulmonary Department, Hospital Universitario Fundación Jiménez Díaz, Madrid.
authors.forename: German
authors.initials: G
authors.lastname: Peces-Barba
authors.affiliation: Pulmonary Department, Hospital de la Santa Creu i Sant Pau, Barcelona.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Solanes-García
authors.affiliation: Pulmonary Department, Hospital Universitario Marqués de Valdecilla, Santander.
authors.forename: Ramón
authors.initials: R
authors.lastname: Agüero
authors.affiliation: Pulmonary Department, Hospital Universitario de Valme, Sevilla; Pulmonary Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba.
authors.forename: Nuria
authors.initials: N
authors.lastname: Feu-Collado
authors.affiliation: Pulmonary Department, Hospital Universitario Clinico San Carlos, Madrid.
authors.forename: Miryam
authors.initials: M
authors.lastname: Calle-Rubio
authors.affiliation: Pulmonary Department, Hospital Universitario de Valme, Sevilla.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alfageme
authors.affiliation: Pulmonary Department, Hospital Universitario y Politécnico de la Fe, Valencia.
authors.forename: Alfredo
authors.initials: A
authors.lastname: de Diego-Damia
authors.affiliation: Pulmonary Department, Hospital de Manacor, Mallorca.
authors.forename: Rosa
authors.initials: R
authors.lastname: Irigaray
authors.affiliation: Pulmonary Department, Hospital General de Castellon, Castellon.
authors.forename: Margarita
authors.initials: M
authors.lastname: Marín
authors.affiliation: CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid; Pulmonary Department, Hospital del Mar, Barcelona.
authors.forename: Eva
authors.initials: E
authors.lastname: Balcells
authors.affiliation: Pulmonary Department, Hospital de Tarrasa, Tarrasa.
authors.forename: Antonia
authors.initials: A
authors.lastname: Llunell
authors.affiliation: Pulmonary Department, Hospital Universitario de Cruces, Bilbao.
authors.forename: Juan Bautista
authors.initials: JB
authors.lastname: Galdiz
authors.affiliation: Pulmonary Department, Hospital General de Calde, Lugo.
authors.forename: Rafael
authors.initials: R
authors.lastname: Golpe
authors.affiliation: Pulmonary Department, Hospital Ciudad de Jaén, Jaén.
authors.forename: Celia
authors.initials: C
authors.lastname: Lacarcel
authors.affiliation: Pulmonary Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cabrera
authors.affiliation: Pulmonary Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria.
authors.forename: Alicia
authors.initials: A
authors.lastname: Marin
authors.affiliation: Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.affiliation: CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lopez-Campos
authors.affiliation: Pulmonary Department, Hospital Universitario Arnau de Vilanova, Valencia.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Soler-Cataluña
authors.affiliation: Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: de-Torres
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005541:Forced Expiratory Volume; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D012372:ROC Curve; D013030:Spain; D011795:Surveys and Questionnaires; D063189:Symptom Assessment