The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease
The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease
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DOI：
10.1056/nejmoa021322
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发表时间：
2004-03-04
影响因子：
158.5
通讯作者：
Cabral, HJ
中科院分区：
文献类型：
--
作者：
Celli, BR;Cote, CG;Cabral, HJ
背景：慢性阻塞性肺疾病(COPD)的特点是气流受限不完全可逆。一个生理变量--一秒用力呼气量(FEV(Sub1))--通常被用来对COPD的严重程度进行分级。然而，COPD患者有FEV(Sub1)不能反映的全身症状。方法：我们首先评估了207名患者，发现四个因素预测死亡风险：体重指数(B)、气流阻塞程度(O)和呼吸困难的程度(D)以及通过6分钟步行试验测量的运动能力(E)。我们使用这些变量构建了BODE指数，这是一个多维的10分制，得分越高，死亡风险越高。然后，我们在625名患者中前瞻性地验证了该指数，结果变量为任何原因和呼吸系统原因的死亡。结果：前207名患者中有25人死亡，验证队列中有162人死亡(26%)。在验证队列中，61%的死亡是由于呼吸功能不全，14%是心肌梗死，12%是肺癌，13%是其他原因。BODE得分越高的患者死亡风险越高；BODE得分每增加1分，任何死因死亡的危险比为1.34(95%可信区间，1.26至1.42；P
BACKGROUND:Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible limitation in airflow. A physiological variable -- the forced expiratory volume in one second (FEV(sub 1)) -- is often used to grade the severity of COPD. However, patients with COPD have systemic manifestations that are not reflected by the FEV(sub 1). We hypothesized that a multidimensional grading system that assessed the respiratory and systemic expressions of COPD would better categorize and predict outcome in these patients.METHODS:We first evaluated 207 patients and found that four factors predicted the risk of death in this cohort: the body-mass index (B), the degree of airflow obstruction (O) and dyspnea (D), and exercise capacity (E), measured by the six-minute-walk test. We used these variables to construct the BODE index, a multidimensional 10-point scale in which higher scores indicate a higher risk of death. We then prospectively validated the index in a cohort of 625 patients, with death from any cause and from respiratory causes as the outcome variables.RESULTS:There were 25 deaths among the first 207 patients and 162 deaths (26 percent) in the validation cohort. Sixty-one percent of the deaths in the validation cohort were due to respiratory insufficiency, 14 percent to myocardial infarction, 12 percent to lung cancer, and 13 percent to other causes. Patients with higher BODE scores were at higher risk for death; the hazard ratio for death from any cause per one-point increase in the BODE score was 1.34 (95 percent confidence interval, 1.26 to 1.42; P