Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease

the updated BODE index and the ADO index

Milo A. Puhan, Judith Garcia-Aymerich, Martin Frey, Gerben ter Riet, Josep M. Antó, Alvar G. Agustí, Federico P. Gómez, Roberto Rodríguez-Roisín, Karel GM Moons, Alphons G. Kessels, Ulrike Held

Research output: Contribution to journalArticle

Abstract

Background: The BODE index (including body-mass index, airflow obstruction, dyspnoea, and exercise capacity) was an important contribution to the prognostic assessment of patients with chronic obstructive pulmonary disease (COPD). However, no study has assessed whether the risk of mortality predicted by the BODE index matches the observed mortality in different populations. We assessed the calibration of the BODE index, updated it to improve its calibration, and developed and validated a simplified index for use in primary-care settings. Methods: We included 232 patients from the Swiss Barmelweid cohort with longstanding and severe COPD and 342 patients from the Spanish Phenotype and Course of COPD cohort study who had had their first hospital admission due to moderate-to-severe COPD. In both cohorts we compared the observed 3-year risk of all-cause mortality with the risk predicted by the BODE index. We then updated the BODE index and developed a simplified ADO index (including age, dyspnoea, and airflow obstruction) from the Swiss cohort, and validated both in the Spanish cohort. Findings: Calibration of the BODE index was poor, with relative underprediction of 3-year risk of mortality by 36% in the Swiss cohort (median predicted risk 21·7% [IQR 12·7-31·7] vs 34·1% observed risk; p=0·013) and relative overprediction by 39% in the Spanish cohort (16·7% [12·7-31·7] vs 12·0%; p=0·035). The 3-year risk of mortality predicted by both the updated BODE (median 10·7% [8·1-13·8]) and ADO indices (11·8% [9·1-14·3]) matched the observed mortality in the Spanish cohort well (p=0·99 and p=0.98, respectively). Interpretation: Both the updated BODE and ADO indices could lend support to the prognostic assessment of patients with COPD in specialised and primary-care settings. Such assessment enhances the targeting of treatments to individual patients. Funding: Swiss National Science Foundation; Klinik Barmelweid; Fondo de Investigación Sanitaria Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca Mèdiques, Catalonia Government; Spanish Society of Pneumology and Thoracic Surgery; Catalan Foundation of Pneumology; Red RESPIRA; Red RCESP; Fondo de Investigación Sanitaria; Fondo de Investigación Sanitaria; Fundació La Marató de TV3; Novartis Farmacèutica, Spain.

Original languageEnglish (US)
Pages (from-to)704-711
Number of pages8
JournalThe Lancet
Volume374
Issue number9691
DOIs
StatePublished - Sep 4 2009

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Chronic Obstructive Pulmonary Disease
Mortality
Calibration
Pulmonary Medicine
Dyspnea
Spain
Primary Health Care
beta-apocarotenoid-14',13'-dioxygenase
Thoracic Surgery
Body Mass Index
Cohort Studies
Exercise
Phenotype
Health
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Puhan, M. A., Garcia-Aymerich, J., Frey, M., ter Riet, G., Antó, J. M., Agustí, A. G., ... Held, U. (2009). Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index. The Lancet, 374(9691), 704-711. https://doi.org/10.1016/S0140-6736(09)61301-5

Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease : the updated BODE index and the ADO index. / Puhan, Milo A.; Garcia-Aymerich, Judith; Frey, Martin; ter Riet, Gerben; Antó, Josep M.; Agustí, Alvar G.; Gómez, Federico P.; Rodríguez-Roisín, Roberto; Moons, Karel GM; Kessels, Alphons G.; Held, Ulrike.

In: The Lancet, Vol. 374, No. 9691, 04.09.2009, p. 704-711.

Research output: Contribution to journalArticle

Puhan, MA, Garcia-Aymerich, J, Frey, M, ter Riet, G, Antó, JM, Agustí, AG, Gómez, FP, Rodríguez-Roisín, R, Moons, KGM, Kessels, AG & Held, U 2009, 'Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index', The Lancet, vol. 374, no. 9691, pp. 704-711. https://doi.org/10.1016/S0140-6736(09)61301-5
Puhan, Milo A. ; Garcia-Aymerich, Judith ; Frey, Martin ; ter Riet, Gerben ; Antó, Josep M. ; Agustí, Alvar G. ; Gómez, Federico P. ; Rodríguez-Roisín, Roberto ; Moons, Karel GM ; Kessels, Alphons G. ; Held, Ulrike. / Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease : the updated BODE index and the ADO index. In: The Lancet. 2009 ; Vol. 374, No. 9691. pp. 704-711.
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T1 - Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease

T2 - the updated BODE index and the ADO index

AU - Puhan, Milo A.

AU - Garcia-Aymerich, Judith

AU - Frey, Martin

AU - ter Riet, Gerben

AU - Antó, Josep M.

AU - Agustí, Alvar G.

AU - Gómez, Federico P.

AU - Rodríguez-Roisín, Roberto

AU - Moons, Karel GM

AU - Kessels, Alphons G.

AU - Held, Ulrike

PY - 2009/9/4

Y1 - 2009/9/4

N2 - Background: The BODE index (including body-mass index, airflow obstruction, dyspnoea, and exercise capacity) was an important contribution to the prognostic assessment of patients with chronic obstructive pulmonary disease (COPD). However, no study has assessed whether the risk of mortality predicted by the BODE index matches the observed mortality in different populations. We assessed the calibration of the BODE index, updated it to improve its calibration, and developed and validated a simplified index for use in primary-care settings. Methods: We included 232 patients from the Swiss Barmelweid cohort with longstanding and severe COPD and 342 patients from the Spanish Phenotype and Course of COPD cohort study who had had their first hospital admission due to moderate-to-severe COPD. In both cohorts we compared the observed 3-year risk of all-cause mortality with the risk predicted by the BODE index. We then updated the BODE index and developed a simplified ADO index (including age, dyspnoea, and airflow obstruction) from the Swiss cohort, and validated both in the Spanish cohort. Findings: Calibration of the BODE index was poor, with relative underprediction of 3-year risk of mortality by 36% in the Swiss cohort (median predicted risk 21·7% [IQR 12·7-31·7] vs 34·1% observed risk; p=0·013) and relative overprediction by 39% in the Spanish cohort (16·7% [12·7-31·7] vs 12·0%; p=0·035). The 3-year risk of mortality predicted by both the updated BODE (median 10·7% [8·1-13·8]) and ADO indices (11·8% [9·1-14·3]) matched the observed mortality in the Spanish cohort well (p=0·99 and p=0.98, respectively). Interpretation: Both the updated BODE and ADO indices could lend support to the prognostic assessment of patients with COPD in specialised and primary-care settings. Such assessment enhances the targeting of treatments to individual patients. Funding: Swiss National Science Foundation; Klinik Barmelweid; Fondo de Investigación Sanitaria Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca Mèdiques, Catalonia Government; Spanish Society of Pneumology and Thoracic Surgery; Catalan Foundation of Pneumology; Red RESPIRA; Red RCESP; Fondo de Investigación Sanitaria; Fondo de Investigación Sanitaria; Fundació La Marató de TV3; Novartis Farmacèutica, Spain.

AB - Background: The BODE index (including body-mass index, airflow obstruction, dyspnoea, and exercise capacity) was an important contribution to the prognostic assessment of patients with chronic obstructive pulmonary disease (COPD). However, no study has assessed whether the risk of mortality predicted by the BODE index matches the observed mortality in different populations. We assessed the calibration of the BODE index, updated it to improve its calibration, and developed and validated a simplified index for use in primary-care settings. Methods: We included 232 patients from the Swiss Barmelweid cohort with longstanding and severe COPD and 342 patients from the Spanish Phenotype and Course of COPD cohort study who had had their first hospital admission due to moderate-to-severe COPD. In both cohorts we compared the observed 3-year risk of all-cause mortality with the risk predicted by the BODE index. We then updated the BODE index and developed a simplified ADO index (including age, dyspnoea, and airflow obstruction) from the Swiss cohort, and validated both in the Spanish cohort. Findings: Calibration of the BODE index was poor, with relative underprediction of 3-year risk of mortality by 36% in the Swiss cohort (median predicted risk 21·7% [IQR 12·7-31·7] vs 34·1% observed risk; p=0·013) and relative overprediction by 39% in the Spanish cohort (16·7% [12·7-31·7] vs 12·0%; p=0·035). The 3-year risk of mortality predicted by both the updated BODE (median 10·7% [8·1-13·8]) and ADO indices (11·8% [9·1-14·3]) matched the observed mortality in the Spanish cohort well (p=0·99 and p=0.98, respectively). Interpretation: Both the updated BODE and ADO indices could lend support to the prognostic assessment of patients with COPD in specialised and primary-care settings. Such assessment enhances the targeting of treatments to individual patients. Funding: Swiss National Science Foundation; Klinik Barmelweid; Fondo de Investigación Sanitaria Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca Mèdiques, Catalonia Government; Spanish Society of Pneumology and Thoracic Surgery; Catalan Foundation of Pneumology; Red RESPIRA; Red RCESP; Fondo de Investigación Sanitaria; Fondo de Investigación Sanitaria; Fundació La Marató de TV3; Novartis Farmacèutica, Spain.

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