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    BODE Index for COPD Survival

    Predicts survival in COPD patients.
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    INSTRUCTIONS

    Do not use in patients during acute exacerbations of COPD. Do not use to guide therapy. See When to Use for full exclusion criteria.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients with COPD, defined as >20 pack-year smoking history and FEV1/FVC ratio <0.7, measured 20 mins after albuterol given. Do not use if any of the following:

      • Asthma diagnosis.
      • Inability to perform bronchodilator test or 6 Minute Walk Test.
      • MI within four months.
      • Unstable angina.
      • CHF (NYHA class III or IV).
      • Likely to die within 3 years from a cause other than COPD.
    • Should not be used during acute exacerbations. The DECAF Score can be used to predict mortality in acute exacerbations of COPD.
    • The BODE Index is a unique scoring system that uses variables from different domains to predict all-cause mortality and mortality from respiratory causes (respiratory failure, pneumonia or pulmonary embolism) in patients with COPD.
    • Intended for use in patients with stable COPD who are already on appropriate treatment (not acute exacerbations of COPD).
    • Requires FEV1, 6 Minute Walk Test, and mMRC Dyspnea Scale.
    • Not intended to guide or influence treatment. 
    • Better than FEV1 to predict risk of death, hospitalizations and exacerbations of COPD.
    • Widely applicable, requires no special equipment, and is simple to calculate.
    • Better than FEV1 alone at predicting mortality from any cause or respiratory cause.
    • By using the mMRC Dyspnea Scale, it takes into consideration patient’s perception of symptoms.
    • Looks at systemic manifestations of COPD by incorporating BMI and the 6 Minute Walk Test.
    • May be a better predictor of hospitalizations for COPD compared to FEV1 (Ong 2005).
    • May also be a better predictor of COPD exacerbations compared to FEV1 alone (Marin 2009).
    About the Creator
    Dr. Bartolome R. Celli
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    Evidence
    Creator Insights

    Advice

    • Does not predict clinical response to therapy.
    • Does not guide therapy.
    • Best used as an adjunct to discussions with patients regarding a realistic and evidence-based picture of their prognosis.
    • Patients with a higher BODE Index have a higher risk of death from any cause and from respiratory causes (respiratory failure, pneumonia or pulmonary embolism).
    • Patients with a higher BODE Index have a greater number of COPD exacerbations and hospitalizations.

    Management

    The BODE Index is used to predict mortality and has not been studied to guide management.

    Critical Actions

    • Should not be used to guide treatment.
    • Use the BODE Index to help educate patients about their prognosis and to inform discussions regarding goals of care.

    Formula

    Addition of the selected points:

     

    0 points

    1 point

    2 points

    3 points

    FEV1 (% of predicted)

    ≥65

    50–64

    36–49

    ≤35

    6 Minute Walk Distance (m)

    ≥350

    250–349

    150–249

    ≤149

    mMRC Dyspnea Scale

    0–1

    2

    3

    4

    BMI

    >21

    ≤21

    --

    --

    Facts & Figures

    Interpretation:

    BODE Index

    4-year survival

    0–2

    80%

    3–4

    67%

    5–6

    57%

    7–10

    18%

    Survival estimates based on Kaplan-Meier curves from Celli 2004:

    Evidence Appraisal

    The BODE Index was developed by Celli et al in 2004, by independently evaluating multiple variables associated with one year mortality in 207 stable COPD patients. Four variables with the strongest association were selected (BMI, FEV1, mMRC Dyspnea Scale, 6 Minute Walk Test).

    Selected patients were in clinically stable condition on appropriate therapy and stable oxygen requirements for 6 months. Patients with asthma, inability to perform bronchodilator or 6 Minute Walk Test, myocardial infarction within four months, unstable angina, or NYHA class III or IV CHF were excluded.

    The BODE Index was prospectively validated by the same authors in 625 patients across centers in the US, Spain and Venezuela. It performed well to predict death from any cause and death from respiratory cause, with an increase in hazard ratio of 1.34 and 1.62, respectively, for each point increase in the BODE Index.

    A subsequent study by Ong et al in Chest assessed the BODE Index as a predictor of hospitalizations for COPD. The study was completed in 2005 at a university affiliated hospital in Singapore and followed 127 patients with COPD in the outpatient setting. The authors found that the BODE Index performed better than the 2003 GOLD guidelines to predict COPD-related hospital admissions.

    A Spanish study, also by Celli, of 275 patients over 8 years demonstrated that the BODE Index predicted the number and severity of COPD exacerbations better than FEV1.

    Dr. Bartolome R. Celli

    About the Creator

    Bartolome R. Celli, MD, is a professor of medicine at Brigham and Women's Hospital, associated with Harvard Medical School. He specializes in pulmonary and critical care medicine. Dr. Celli’s main research interest is scoring systems in management of COPD.

    To view Dr. Bartolome R. Celli's publications, visit PubMed

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