Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2021, 165(2):139-145 | DOI: 10.5507/bp.2020.035

Introducing a new prognostic instrument for long-term mortality prediction in COPD patients: the CADOT index

Kristian Brat^{a, c}, Michal Svoboda^{b, c}, Karel Hejduk^c, Marek Plutinsky^{a, c}, Jaromir Zatloukal^d, Eva Volakova^d, Patrice Popelkova^e, Barbora Novotna^f, Dita Engova^g, Frits M.E. Franssen^{h, k}, Lowie E.G.W. Vanfleterenⁱ, Martijn A. Spruit^{h, j, k}, Vladimir Koblizek^l

^a Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic

^b Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic

^c Faculty of Medicine, Masaryk University, Brno, Czech Republic

^d Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic

^e Pulmonary Department, University Hospital Ostrava, Czech Republic

^f Pulmonary Department, Bulovka Hospital, Prague, Czech Republic

^g Boehringer Ingelheim s.r.o., Prague, Czech Republic

^h Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands

ⁱ COPD Center, Sahlgrenska University Hospital, Institute of Medicine, University of Gothenburg, Sweden

^j REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium

^k Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands

^l Pulmonary Department, University Hospital Hradec Kralove and Faculty of Medicine Hradec Kralove, Charles University, Czech Republic

Objectives: The BODE (BMI, Obstruction - FEV₁, Dyspnoea - mMRC, Exercise - 6-MWT) and the ADO (Age, Dyspnoea - mMRC, Obstruction - FEV₁) indices are widely used prognosis assessment tools for long-term mortality prediction in COPD patients but subject to limitations for use in daily clinical practice. The aim of this research was to construct a prognostic instrument that prevents these limitations and which would serve as a complementary prognostic tool for clinical use in these patients. Methods and Participants. The data of 699 COPD subjects were extracted from the Czech Multicentre Research Database (CMRD) of COPD patients (the derivation cohort) and analysed to identify factors associated with the long-term risk of mortality. These were entered into the ROC analysis and reclassification analysis. Those with the strongest discriminative power were used to construct the new index (CADOT). The new index was validated on 187 patients of the CIROCO+ cohort (Netherlands; the validation cohort). Results. The CADOT was constructed by adding two newly identified prognosis-determining factors, chronic heart failure (CHF) and TL_CO, to the ADO index. In a head-to-head comparison, the CADOT index showed highest c-statistic values compared to the BODE and ADO indices (0.701 vs 0.677 vs 0.644, respectively). The prognostic power was more definitive when applied to the Dutch validation (CIROCO+) cohort (0.842 vs 0.799 vs 0.825, respectively). Conclusions. The CADOT index has comparable prognostic power to the BODE and ADO indices. The CADOT is complementary/an alternative to the BODE (if 6-MWT is not feasible) and ADO (with less dependence on the age factor) indices. Trial registration: ClinicalTrials.gov (NCT01923051).

Keywords: COPD, prognostic index, pulmonary function, mortality

Received: April 3, 2020; Revised: July 10, 2020; Accepted: August 10, 2020; Prepublished online: September 10, 2020; Published: June 10, 2021  Show citation