Biomedical papers, 2016 (vol. 160), issue 2

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016, 160(2):211-218 | 10.5507/bp.2016.030

Chronic obstructive pulmonary disease prognostic score: A new index

Nobuyuki Horitaa, Vladimir Koblizekb, Marek Plutinskyc, Barbora Novotnab, Karel Hejdukd, Takeshi Kanekoa
a Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
b Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
c Department of Pneumology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
d Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

Background: The evaluation of chronic obstructive pulmonary disease (COPD) has been shifting from spirometry to focus on the patients' overall health. Despite the existence of many COPD prognostic scales, there remains a large gap for improvement, in particular a scale that incorporates the current focus on overall health.

Methods: We proposed a new prognostic scale (the COPD Prognostic Score) through discussion among the authors based on published studies. Validation was retrospective, using data from the National Emphysema Treatment Trial.

Results: The scores ranged from 0-16, where 16 indicated the poorest prognosis. We assigned 4 points each for forced expiratory volume in one second (%predicted), the modified Medical Research Council dyspnea scale, and age; 2 points for the hemoglobin level; and one point each for decreased activity and respiratory emergency admission in the last two years. The validation cohort included 607 patients and consisted of 388 men (73.9%) and 219 women (36.1%), mean age 67 ± 6 years and an average forced expiratory volume in one second (% predicted) of 27 ± 7%. A one-point increase in the score was associated with increased all-cause death, with a hazard ratio of 1.28 (95%CI: 1.21-1.36. P < 0.001). The areas under the receiver operating characteristic curves for two-year and five-year all-cause death for the new scale were 0.72 and 0.66, respectively. These values were higher than those given by the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index and age, dyspnea, airway obstruction (ADO) index.

Conclusion: The preliminary validation for a new COPD prognostic scale: the COPD Prognostic Score was developed with promising results thus far. Above mentioned 16-point score accurately predicted 2-year and 5-year all-cause mortality among subjects who suffered from severe and very severe COPD.

Keywords: COPD, prognosis, dyspnea, age, spirometry, hemoglobin

Received: March 23, 2016; Accepted: May 24, 2016; Prepublished online: June 16, 2016; Published: June 24, 2016


References

  1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2014. Available from: http://www.goldcopd.org/.(accessed on 1st Nov., 2014).
  2. World Health Organization. Chronic respiratory disease: Chronic obstructive pulmonary disease (COPD): Burden of COPD. Available from: http://www.who.int/respiratory/copd/burden/en/ (accessed on 15th Jan., 2015)
  3. Anthonisen NR, Wright EC, Hodgkin JE. Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 1986;133(1):14-20. Go to original source... Go to PubMed...
  4. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Plata V, Cabral HJ. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350(10):1005-12. Go to original source... Go to PubMed...
  5. Puhan MA, Garcia-Aymerich J, Frey M, ter Riet G, Antó JM, Agusti AG, Gómez FP, Rodríguez-Roisín R, Moons KG, Kessels AG, Held U. Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index. Lancet 2009;374(9691):704-11. Go to original source... Go to PubMed...
  6. Esteban C, Quintana JM, Aburto M, Moraza J, Capelastegui A. A simple score for assessing stable chronic obstructive pulmonary disease. QJM 2006;99(11):751-9. Go to original source... Go to PubMed...
  7. Esteban C, Quintana JM, Moraza J, Aburto M, Aguirre U, Aguirregomoscorta JI, Aizpiri S, Basualdo LV, Capelastegui A. BODE-Index vs HADO-score in chronic obstructive pulmonary disease: Which one to use in general practice? BMC Med 2010;8:28. Go to original source... Go to PubMed...
  8. Briggs A, Spencer M, Wang H, Mannino D, Sin DD. Development and validation of a prognostic index for health outcomes in chronic obstructive pulmonary disease. Arch Intern Med 2008;168(1):71-9. Go to original source... Go to PubMed...
  9. Esteban C, Arostegui I, Moraza J, Aburto M, Quintana JM, Pérez-Izquierdo J, Aizpiri S, Capelastegui A. Development of a decision tree to assess the severity and prognosis of stable COPD. Eur Respir J 2011;38(6):1294-300. Go to original source... Go to PubMed...
  10. Williams JE, Green RH, Warrington V, Steiner MC, Morgan MD, Singh SJ. Development of the i-BODE: validation of the incremental shuttle walking test within the BODE index. Respir Med 2012;106(3):390-6. Go to original source... Go to PubMed...
  11. Moberg M, Vestbo J, Martinez G, Williams JE, Ladelung S, Lange P, Ringbaek T. Validation of the i-BODE index as a predictor of hospitalization and mortality in patients with COPD Participating in pulmonary rehabilitation. COPD 2014;11(4):381-7. Go to original source... Go to PubMed...
  12. Rationale and design of the National Emphysema Treatment Trial (NETT): A prospective randomized trial of lung volume reduction surgery. J Thorac Cardiovasc Surg 1999;118(3):518-28. Go to original source... Go to PubMed...
  13. Nguyen HQ, Altinger J, Carrieri-Kohlman V, Gormley JM, Stulbarg MS. Factor analysis of laboratory and clinical measurements of dyspnea in patients with chronic obstructive pulmonary disease. J Pain Symptom Manage 2003;25(2):118-27. Go to original source... Go to PubMed...
  14. van den Bemt L, Smeele I, van Weel C. Prognostic assessment of patients with COPD. Lancet 2009;374(9705):1886. Go to original source... Go to PubMed...
  15. Mohapatra PR. Prognostic assessment of patients with COPD. Lancet 2009;374(9705):1885-6. Go to original source... Go to PubMed...
  16. Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 2002;121(5):1434-40. Go to original source... Go to PubMed...
  17. Hajiro T, Nishimura K, Tsukino M, Ikeda A, Oga T, Izumi T. A comparison of the level of dyspnea vs disease severity in indicating the health-related quality of life of patients with COPD. Chest 1999;116(6):1632-7. Go to original source... Go to PubMed...
  18. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest 1988;93(3):580-6. Go to original source... Go to PubMed...
  19. Eakin EG, Resnikoff PM, Prewitt LM, Ries AL, Kaplan RM. Validation of a new dyspnea measure: the UCSD Shortness of Breath Questionnaire. University of California, San Diego. Chest 1998;113(3):619-24.
  20. Horita N, Miyazawa N, Morita S, Kojima R, Kimura N, Kaneko T, Ishigatsubo Y. Small, moderate, and large changes, and the minimum clinically important difference in the University of California, San Diego Shortness of Breath Questionnaire. COPD 2014;11(1):26-32. Go to original source... Go to PubMed...
  21. Martinez FJ, Foster G, Curtis JL, Criner G, Weinmann G, Fishman A, DeCamp MM, Bendit J, Sciurba F, Make B, Mohsenifar Z, Diaz P, Hoffman E, Wise R; NETT Research Group. Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med 2006;173(12):1326-34. Go to original source... Go to PubMed...
  22. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis 1992;145(6):1321-7. Go to original source... Go to PubMed...
  23. Horita N, Yomota M, Sasaki M, Morita S,Shinkai M, Ishigatsubo Y, Kaneko T. Evaluation of the chronic obstructive pulmonary disease assessment test in Japanese outpatients. Clin Respir J 2014;8(2):213-9. Go to original source... Go to PubMed...
  24. Domingo-Salvany A, Lamarca R, Ferrer M, Garcia-Aymerich J, Alonso J, Félez M, Khalaf A, Marrades RM, Monsó E, Serra-Batlles J, Antó JM. Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002;166(5):680-5. Go to original source... Go to PubMed...
  25. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Antó JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax 2006;61(9):772-8. Go to original source... Go to PubMed...
  26. Schnohr P, Scharling H, Jensen JS. Changes in leisure-time physical activity and risk of death: an observational study of 7,000 men and women. Am J Epidemiol 2003;158(7):639-44. Go to original source... Go to PubMed...
  27. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5(6):649-55. Go to original source... Go to PubMed...
  28. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;160(6):1856-61. Go to original source... Go to PubMed...
  29. Connors AF, Jr., Dawson NV, Thomas C, Harrell FE Jr., Desbiens N, Fulkerson WJ, Kussin P, Bellamy P, Goldman L, Knaus WA. Outcomes following acute exacerbation of severe chronic obstructive lung disease. Am J Resp Crit Care Med 1996;154(4 Pt 1):959-67. Go to original source... Go to PubMed...
  30. Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedi E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005;60(11):925-31. Go to original source... Go to PubMed...
  31. Miyamoto K, Aida A, Nishimura M, Aiba M, Kira S, Kawakami Y. Gender effect on prognosis of patients receiving long-term home oxygen therapy. The Respiratory Failure Research Group in Japan. Am J Respir Crit Care Med 1995;152(3):972-6. Go to original source... Go to PubMed...
  32. de Torres JP, Cote CG, López MV, Casanova C, Diaz O, Marin JM, Pinto-Plata V, de Oca MM, Nekach H, Dordelly LJ, Aquiire-Jaime A, Celli BR. Sex differences in mortality in patients with COPD. Eur Respir J 2009;33(3):528-35. Go to original source... Go to PubMed...
  33. Machado MC, Krishnan JA, Buist SA, Bilderback AL, Fazolo GP, Santarosa MG, Queiroga F Jr., Vollmer WM. Sex differences in survival of oxygen-dependent patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006;174(5):524-9. Go to original source... Go to PubMed...
  34. Similowski T, Agustí A, MacNee W, Schönhofer B. The potential impact of anaemia of chronic disease in COPD. Eur Respir J 2006;27(2):390-6. Go to original source... Go to PubMed...
  35. Chambellan A, Chailleux E, Similowski T, ANTADIR Observatory Group. Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy. Chest 2005;128(3):1201-8. Go to original source... Go to PubMed...
  36. Cote C, Zilberberg MD, Mody SH, Dordelly LJ, Celli B. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J 2007;29(5):923-9. Go to original source... Go to PubMed...
  37. Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR. Impact of anemia on hospitalization and mortality in older adults. Blood 2006;107(10):3841-6. Go to original source... Go to PubMed...
  38. Novotna B, Koblizek V, Zatloukal J, Plutinsky M, Hejduk K, Zbozinkova Z, Jarkovsky J, Sobotik O, Dvorak T, ©afránek P. Czech multicenter research database of severe COPD. Int J Chron Obstruct Pulmonon Dis 2014;9:1265-74. Go to PubMed...
  39. Koblizek V, Tomsova M, Cermakova E, Papousek P, Pracharova S. Mandalia RA, Ceral J, Novosad J, Fila L, Sedlak V, Ruta J, Bartos V, Salajka F, Hrnciarik M. Impairment of nasal mucociliary clearance in formel smokers with stable chronic obstructive pulmonary disease relates to the presence of a chronic bronchitis phenotype. Rhinology 2011;49(4):397-406. Go to PubMed...