The BODE index is routinely used to determine a patient’s risk of dying from COPD. It uses risk factors such as body-mass index, airflow obstruction, dyspnea, and exercise; but since exercise capacity is often not available in practice, the BODE index is rarely used in primary care settings—where most COPD patients are managed.
Milo Puhan, PhD, and colleagues from the Johns Hopkins Bloomberg School of Public Health set out to verify how accurately the BODE index predicts patients at highest risk. The investigators compared whether a patient’s risk of death predicted by the BODE index matched the observed 3-year risk of all-cause mortality in two different COPD populations. Their goal was to modify the index to improve its predictive accuracy and to develop a new simple score using age, shortness of breath, and airflow obstruction (ADO index). The investigators looked at 232 Swiss patients with longstanding, severe COPD and 342 Spanish patients who had their first hospital admission due to moderate-to-severe COPD. Findings showed that the original BODE index was poor at predicting 3-year risk of mortality (36% relative underprediction in the Swiss cohort, and a 39% relative overprediciton in the Spanish cohort). The updated BODE and ADO indices gave more accurate predictions of 3-year mortality and matched the observed mortality in the Spanish cohort, with little difference between predicted and observed mortality.
The authors commented: “The simplified points system for the updated BODE and ADO indices … allows clinicians to identify patients at moderate or high risk of mortality, for which more comprehensive treatment with respiratory rehabilitation, for example, might be appropriate to reduce their risk.”
The [removed]study[/removed] was published in a special August 29 COPD edition of the Lancet.