Prognostic assessment in COPD without lung function: the B-AE-D indices
Boeck L (1), Soriano JB (2), Brusse-Keizer M (3), Blasi F (4), Kostikas K (5), Boersma W (6), Milenkovic B (7), Louis R (8), Lacoma A (9), Djamin R (10), Aerts J (10), Torres A (11), Rohde G (12), Welte T (13), Martinez-Camblor P (14), Rakic J (1), Scherr A (1), Koller M (15), van der Palen J (3), Marin JM (16), Alfageme I (17), Almagro P (18), Casanova C (19), Esteban C (20), Soler-Cataluña JJ (21), de-Torres JP (22), Miravitlles M (23), Celli BR (24), Tamm M (1), Stolz D (25).
(1) Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland.
(2) Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.
(3) Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
(4) Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy.
(5) University of Thessaly Medical School, Larissa, Greece.
(6) Dept of Pneumology, Medisch Centrum, Alkmaar, The Netherlands.
(7) Faculty of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
(8) Dept of Pneumology, University of Liege, Liege, Belgium.
(9) Dept of Microbiology, Hospital Universitari Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Badalona, Spain.
(10) Dept of Pneumology, Amphia Hospital, Breda, The Netherlands.
(11) Dept of Pneumology, Hospital Clinic, Barcelona, Spain.
(12) Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
(13) Dept of Pneumology, Medizinische Hochschule, Hannover, Germany.
(14) Universidad Autónoma de Chile, Santiago, Chile.
(15) Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
(16) Respiratory Dept, Hospital Universitario Miguel Servet, Zaragoza, CIBER Enfermedades Respiratoria, Madrid, Spain.
(17) Respiratory Dept, Valme University Hospital, Seville, Spain.
(18) Internal Medicine Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
(19) Respiratory Dept, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
(20) Respiratory Dept, Hospital Galdakao-Usansolo, Bizkaia, Spain.
(21) Pneumology Dept, Hospital Arnau de Vilanova-Lliria, Valencia, Spain.
(22) Respiratory Dept, Clínica Universidad de Navarra, Pamplona, Spain.
(23) Pneumology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
(24) Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA.
(25) Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
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.
CITATION Eur Respir J. 2016 Jun;47(6):1635-44. doi: 10.1183/13993003.01485-2015. Epub 2016 Apr 21