title: Comparison of global initiative for chronic obstructive pulmonary disease 2013 classification and body mass index, airflow obstruction, dyspnea, and exacerbations index in predicting mortality and exacerbations in elderly adults with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To examine whether the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 2013 revision offers greater predictive ability than the body mass index, airflow obstruction, dyspnea, and exacerbations (BODEx) index in elderly adults with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University-affiliated medical center.
  
  
  METHODS
  Taiwanese outpatients with COPD (N = 354).
  
  
  METHODS
  Participants were classified as Group A (low risk with mild dyspnea), Group B (low risk with more-severe dyspnea), Group C (high risk with mild dyspnea), and Group D (high risk with more-severe dyspnea) for GOLD 2013 and from Quartile 1 (0-2 points) to 4 (7-9 points) for BODEx score. Ability to predict exacerbations and mortality was compared using logistic regression analysis with receiver operating characteristic (ROC) curve estimations and area under the ROC curve (AUC).
  
  
  RESULTS
  Mortality was 14.1% for GOLD Group A, 14.5% for Group B, 6.5% for Group C, and 35.8% for Group D and 15.2% for BODEx Quartile 1, 22.5% for Quartile 2, 28.1% for Quartile 3, and 79.2% for Quartile 4. Risk of exacerbation relative to Group A was 1.7 (95% confidence interval (CI) = 0.6-4.3) for Group B, 14.1 (95% CI = 4.6-43.2) for Group C, and 17.9 (95% CI = 7.6-42.0) for Group D. The AUC for the GOLD classification and BODEx index were 0.65 and 0.67 for mortality (P = .60) and 0.79 and 0.73 for exacerbation (P = .03).
  
  
  CONCLUSIONS
  The GOLD 2013 classification performed well in identifying individuals at risk of exacerbations, and its predictive ability for exacerbations was better than that of the BODEx index, although the predictive ability for mortality in elderly adults with COPD was poor for both indices.
authors: Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin, Taiwan.
authors: Chiung-Zuei
authors: CZ
authors: Chen
authors: Chih-Ying
authors: CY
authors: Ou
authors: Chun-Hsiang
authors: CH
authors: Yu
authors: Szu-Chun
authors: SC
authors: Yang
authors: Han-Yu
authors: HY
authors: Chang
authors: Tzuen-Ren
authors: TR
authors: Hsiue
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D013624:Taiwan
keywords: BODEx; chronic obstructive pulmonary disease; elderly adults; exacerbations; mortality