Abstract
The BODE (BMI, Obstruction - FEV1, Dyspnoea - mMRC, Exercise - 6-MWT) and the ADO (Age, Dyspnoea - mMRC, Obstruction - FEV1) indices are widely used prognosis assessment tools for long-term mortality prediction in COPD patients but subject to limitations for use in daily clinical practice. The aim of this research was to construct a prognostic instrument that prevents these limitations and which would serve as a complementary prognostic tool for clinical use in these patients. The data of 699 COPD subjects were extracted from the Czech Multicentre Research Database (CMRD) of COPD patients (the derivation cohort) and analysed to identify factors associated with the long-term risk of mortality. These were entered into the ROC analysis and reclassification analysis. Those with the strongest discriminative power were used to construct the new index (CADOT). The new index was validated on 187 patients of the CIROCO+ cohort (Netherlands; the validation cohort). The CADOT was constructed by adding two newly identified prognosis-determining factors, chronic heart failure (CHF) and TLCO, to the ADO index. In a head-to-head comparison, the CADOT index showed highest c-statistic values compared to the BODE and ADO indices (0.701 vs 0.677 vs 0.644, respectively). The prognostic power was more definitive when applied to the Dutch validation (CIROCO+) cohort (0.842 vs 0.799 vs 0.825, respectively). The CADOT index has comparable prognostic power to the BODE and ADO indices. The CADOT is complementary/an alternative to the BODE (if 6-MWT is not feasible) and ADO (with less dependence on the age factor) indices. ClinicalTrials.gov (NCT01923051).
Highlights
According to the latest World Health Organization data, chronic obstructive pulmonary disease (COPD) was the third leading cause of death worldwide, claiming approximately 3 million lives in 2016
Two of the 3 parameters determining the ADO score may be associated with other confounders – the specificity of the mMRC score and the age factor
Parameters assessed at enrolment included demographics, patient history data [general practitioners’ (GPs’) and specialists’ records], symptoms [dyspnoea – mMRC score[15], COPD Assessment Test (CAT)], quality of life measures [St George's Respiratory Questionnaire (SGRQ)], treatment, pulmonary functions and other clinical examinations
Summary
According to the latest World Health Organization data, chronic obstructive pulmonary disease (COPD) was the third leading cause of death worldwide, claiming approximately 3 million lives in 2016 (ref.[1]). COPD is considered a heterogeneous syndrome with inter-individual differences in disease manifestation, comorbidity and long-term mortality risk[4,5]. For this reason, accurate tools for estimating the life expectancy of COPD patients are warranted[6,7]. Two of the 3 parameters determining the ADO score may be associated with other confounders – the specificity of the mMRC score (alternative causes of dyspnoea – pulmonary “other-than-COPD”, cardiogenic, extrathoracic, neuromuscular, systemic, etc.) and the age factor (mortality risk/rate is strongly determined by age – the “Gompertz-Makeham Law of Mortality”) (ref.[9,12,13])
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