Reassessing the BODE score as a criterion for listing COPD patients for lung transplantation

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Abstract

Background: The BODE score (incorporating body mass index, airflow obstruction, dyspnea and exercise capacity) is used for the timing of listing for lung transplantation (LTx) in COPD, based on survival data from the original BODE cohort. This has limitations, because the original BODE cohort differs from COPD patients who are candidates for LTx and the BODE does not include parameters that may influence survival. Our goal was to assess whether parameters such as age, smoking status and diffusion indices significantly influence survival in the absence of LTx, independently of the BODE.

Methods: In the present cohort study, the BODE was prospectively assessed in COPD patients followed in a tertiary care hospital with an LTx program. The files of 469 consecutive patients were reviewed for parameters of interest (age, gender, smoking status and diffusing capacity of the lungs for carbon monoxide [DL,CO]) at the time of BODE assessment, as well as for survival status. Their influence on survival independent of the BODE score was assessed, as well as their ability to predict survival in patients aged less than 65 years.

Results: A Cox regression model showed that the BODE score, age and DL,CO were independently related to survival ( P-values <0.001), as opposed to smoking status. Survival was better in patients aged less than 65 in the first ( P=0.004), third ( P=0.002) and fourth BODE quartiles ( P=0.008). The difference did not reach significance in the second quartile ( P=0.13). Median survival for patients aged less than 65 in the fourth BODE quartile was 55 months. According to a receiver operating characteristic curve analysis, the BODE score as well as FEV 1 and DL,CO fared similarly in predicting survival status at 5 years in patients aged less than 65 years.

Conclusion: Age and DL,CO add to the BODE score to predict survival in COPD. Assessing survival using tools tested in cohorts of patients younger than 65 years is warranted for improving the listing of patients for LTx.

Original languageEnglish
Pages (from-to)3963-3970
Number of pages8
JournalInternational Journal of COPD
Volume13
DOIs
Publication statusPublished - 24 Dec 2018

Keywords

  • Age
  • BODE index
  • CO
  • COPD
  • DL
  • Gender
  • Smoking status
  • Survival
  • Predictive Value of Tests
  • Waiting Lists/mortality
  • Age Factors
  • Humans
  • Middle Aged
  • Male
  • Airway Resistance
  • Smoking/adverse effects
  • Patient Selection
  • Dyspnea/diagnosis
  • Lung Transplantation/adverse effects
  • Clinical Decision-Making
  • Female
  • Retrospective Studies
  • Body Mass Index
  • Severity of Illness Index
  • Risk Assessment
  • Risk Factors
  • Decision Support Techniques
  • Pulmonary Disease, Chronic Obstructive/diagnosis
  • Pulmonary Diffusing Capacity
  • Lung/physiopathology
  • Exercise Tolerance
  • Sex Factors
  • Aged
  • Health Status

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