Clinical Investigation
BODE Index and GOLD Staging as Predictors of 1-Year Exacerbation Risk in Chronic Obstructive Pulmonary Disease

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Abstract

Background

The body mass index/airflow obstruction/dyspnea/exercise capacity (BODE) index and global initiative for chronic obstructive lung disease (GOLD) staging system are validated measures to define disease severity and to predict survival in chronic obstructive pulmonary disease (COPD). We aimed to investigate the influence of BODE classes (score: 0–2, 3–4, 5–7, and 7–10) and GOLD stages (I, II, III, and IV) on the moderate/severe exacerbation occurrence risk in a cohort of 120 mild/very severe stable patients with COPD.

Methods

Demographics, clinical evaluation, spirometry, peripheral oxygen saturation, body composition, 6-minute walking distance, dyspnea, and quality of life measurements were obtained at baseline. Patients were followed up for 1 year or until death, and information on exacerbation was collected.

Results

The median annual exacerbation rate was 0.8. Logistic regression showed that the relationship between the risk for moderate/severe exacerbations during a 1-year follow-up for the GOLD stage was odds ratio: 2.01;95% confidence interval: 1.39–2.98 and for the BODE index was odds ratio: 2.08; 95% confidence interval: 1.27–3.61. The area under the receiver-operator curve to predict exacerbation during the 1-year follow-up was 0.69 for the GOLD stage and 0.62 for the BODE index. Adjusted multiple logistic regression selected only older age and lower peripheral oxygen saturation as risk factors for COPD exacerbation in the 1-year follow-up.

Conclusions

In summary, our study shows that unidimensional GOLD classification and multidimensional BODE index staging systems seem to have similar clinical utility in predicting exacerbation in ambulatory COPD patients with COPD. However, variables not included in both systems seem to be the main predictors of the exacerbation risk.

Section snippets

Patients

One hundred twenty consecutive patients with COPD with a wide range of disease severity were recruited from the outpatient clinic of a single institution between July 2004 and August 2006. Major inclusion criteria were clinical diagnosis of COPD according to the criteria set out in GOLD 2003 and the Brazilian Thoracic Society (BTS)17., 18.: age ≥ 40 years, smoking history ≥ 10 pack-years, and a postbronchodilator FEV1/forced vital capacity ratio < 70%. Disease severity was categorized according to

RESULTS

Baseline characteristics of COPD according to the presence or absence of exacerbation during follow-up are presented in Table 1. Patients with COPD (71% men) with a mean age of 65 ± 9.5 years were evaluated. A total of 20% were in GOLD stage I, 38% in GOLD stage II, 17% in GOLD stage III, and 25% in GOLD stage IV. A total of 62.5% were in BODE class 1, 22.5% in BODE class 2, and 15% in BODE classes 3 and 4. Sixty patients (50%) presented with at least 1 exacerbation during follow-up; median

DISCUSSION

This prospective study compared the GOLD staging system and the BODE index as predictors of exacerbation in a cohort of stable ambulatory patients with COPD with a wide range of airway obstruction during the 1-year period. Results of the logistic regression and ROC analysis showed that the influences of the BODE index and the GOLD stage on exacerbation risk during the first year of follow-up was similar. In an adjusted analysis, we identified that more advanced age and lower SpO2 were

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    This study was supported by a Research Grant from FAPESP (Fundação de Amparo á Pesquisa do Estado de São Paulo, São Paulo, Brazil) 04/00517-4.

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