TY - JOUR
T1 - Reassessing the BODE score as a criterion for listing COPD patients for lung transplantation
AU - Marchand, Éric
N1 - Publisher Copyright:
© 2018 Pirard and Marchand.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/12/24
Y1 - 2018/12/24
N2 - 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.
AB - 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.
KW - Age
KW - BODE index
KW - CO
KW - COPD
KW - DL
KW - Gender
KW - Smoking status
KW - Survival
KW - Predictive Value of Tests
KW - Waiting Lists/mortality
KW - Age Factors
KW - Humans
KW - Middle Aged
KW - Male
KW - Airway Resistance
KW - Smoking/adverse effects
KW - Patient Selection
KW - Dyspnea/diagnosis
KW - Lung Transplantation/adverse effects
KW - Clinical Decision-Making
KW - Female
KW - Retrospective Studies
KW - Body Mass Index
KW - Severity of Illness Index
KW - Risk Assessment
KW - Risk Factors
KW - Decision Support Techniques
KW - Pulmonary Disease, Chronic Obstructive/diagnosis
KW - Pulmonary Diffusing Capacity
KW - Lung/physiopathology
KW - Exercise Tolerance
KW - Sex Factors
KW - Aged
KW - Health Status
UR - http://www.scopus.com/inward/record.url?scp=85058460237&partnerID=8YFLogxK
U2 - 10.2147/copd.s182483
DO - 10.2147/copd.s182483
M3 - Article
C2 - 30573956
SN - 1176-9106
VL - 13
SP - 3963
EP - 3970
JO - International Journal of COPD
JF - International Journal of COPD
ER -