Prognostic assessment in COPD without lung function: the B-AE-D indices.
Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function.The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988).Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer-Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer-Lemeshow test all p>0.05).The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk.
Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland.
Lucas
L
Boeck
Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.
Joan B
0000-0001-9740-2994
JB
Soriano
Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
Marjolein
0000-0003-1781-5794
M
Brusse-Keizer
Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy.
Francesco
F
Blasi
University of Thessaly Medical School, Larissa, Greece.
Konstantinos
K
Kostikas
Dept of Pneumology, Medisch Centrum, Alkmaar, The Netherlands.
Wim
W
Boersma
Faculty of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
Branislava
B
Milenkovic
Dept of Pneumology, University of Liege, Liege, Belgium.
Renaud
R
Louis
Dept of Microbiology, Hospital Universitari Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Badalona, Spain.
Alicia
A
Lacoma
Dept of Pneumology, Amphia Hospital, Breda, The Netherlands.
Remco
R
Djamin
Dept of Pneumology, Amphia Hospital, Breda, The Netherlands.
Joachim
J
Aerts
Dept of Pneumology, Hospital Clinic, Barcelona, Spain.
Antoni
A
Torres
Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Gernot
G
Rohde
Dept of Pneumology, Medizinische Hochschule, Hannover, Germany.
Tobias
T
Welte
Universidad Autónoma de Chile, Santiago, Chile.
Pablo
P
Martinez-Camblor
Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland.
Janko
J
Rakic
Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland.
Andreas
A
Scherr
Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
Michael
M
Koller
Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
Job
J
van der Palen
Respiratory Dept, Hospital Universitario Miguel Servet, Zaragoza, CIBER Enfermedades Respiratoria, Madrid, Spain.
Jose M
JM
Marin
Respiratory Dept, Valme University Hospital, Seville, Spain.
Inmaculada
I
Alfageme
Internal Medicine Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
Pere
P
Almagro
Respiratory Dept, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
Ciro
C
Casanova
Respiratory Dept, Hospital Galdakao-Usansolo, Bizkaia, Spain.
Cristobal
C
Esteban
Pneumology Dept, Hospital Arnau de Vilanova-Lliria, Valencia, Spain.
Juan J
JJ
Soler-Cataluña
Respiratory Dept, Clínica Universidad de Navarra, Pamplona, Spain.
Juan P
JP
de-Torres
Pneumology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Marc
M
Miravitlles
Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
Bartolome R
BR
Celli
Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland.
Michael
M
Tamm
Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland daiana.stolz@usb.ch.
Daiana
D
Stolz
D000368:Aged; D015992:Body Mass Index; D004417:Dyspnea / Q000473:pathology; D015444:Exercise; D005260:Female; D005541:Forced Expiratory Volume; D006020:Glycopeptides / Q000097:blood; D006801:Humans; D007249:Inflammation; D008137:Longitudinal Studies; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010100:Oxygen / Q000737:chemistry; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013147:Spirometry; D016896:Treatment Outcome
D006020:Glycopeptides; C048197:copeptins; D010100:Oxygen