Longitudinal change in the BODE index predicts mortality in severe emphysema

Fernando J. Martinez, MeiLan K. Han, Adin Cristian Andrei, Robert Wise, Susan Murray, Jeffrey L. Curtis, Alice Sternberg, Gerard Criner, Steven E. Gay, John Reilly, Barry Make, Andrew L. Ries, Frank Sciurba, Gail Weinmann, Zab Mosenifar, Malcolm DeCamp, Alfred P. Fishman, Bartolome R. Celli

Research output: Contribution to journalArticle

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Abstract

Rationale: The predictive value of longitudinal change in BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index has received limited attention. We hypothesized that decrease in a modified BODE (mBODE) would predict survival in National Emphysema Treatment Trial (NETT) patients. Objectives: To determine how the mBODE score changes in patients with lung volume reduction surgery versus medical therapy and correlations with survival. Methods: Clinical data were recorded using standardized instruments. The mBODE was calculated and patient-specific mBODE trajectories during 6, 12, and 24 months of follow-up were estimated using separate regressions for each patient. Patients were classified as having decreasing, stable, increasing, or missing mBODE based on their absolute change from baseline. The predictive ability of mBODE change on survival was assessed using multivariate Cox regression models. The index of concordance was used to directly compare the predictive ability of mBODE and its separate components. Measurements and Main Results: The entire cohort (610 treated medically and 608 treated surgically) was characterized by severe airflow obstruction, moderate breathlessness, and increased mBODE at baseline. A wide distribution of change in mBODE was seen at follow-up. An increase in mBODE of more than 1 point was associated with increased mortality in surgically and medically treated patients. Surgically treated patients were less likely to experience death or an increase greater than 1 in mBODE. Indices of concordance showed that mBODE change predicted survival better than its separate components. Conclusions: The mBODE demonstrates short- and intermediate-term responsiveness to intervention in severe chronic obstructive pulmonary disease. Increase in mBODE of more than 1 point from baseline to 6, 12, and 24 months of follow-up was predictive of subsequent mortality. Change in mBODE may prove a good surrogate measure of survival in therapeutic trials in severe chronic obstructive pulmonary disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00000606).

Original languageEnglish (US)
Pages (from-to)491-499
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume178
Issue number5
DOIs
StatePublished - Sep 1 2008

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Emphysema
Mortality
Survival
Dyspnea
Chronic Obstructive Pulmonary Disease
Pneumonectomy
Proportional Hazards Models
Body Mass Index
Therapeutics
Clinical Trials
Exercise

Keywords

  • Chronic obstructive pulmonary disease
  • Multi-dimensional index
  • Survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Martinez, Fernando J. ; Han, MeiLan K. ; Andrei, Adin Cristian ; Wise, Robert ; Murray, Susan ; Curtis, Jeffrey L. ; Sternberg, Alice ; Criner, Gerard ; Gay, Steven E. ; Reilly, John ; Make, Barry ; Ries, Andrew L. ; Sciurba, Frank ; Weinmann, Gail ; Mosenifar, Zab ; DeCamp, Malcolm ; Fishman, Alfred P. ; Celli, Bartolome R. / Longitudinal change in the BODE index predicts mortality in severe emphysema. In: American journal of respiratory and critical care medicine. 2008 ; Vol. 178, No. 5. pp. 491-499.
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abstract = "Rationale: The predictive value of longitudinal change in BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index has received limited attention. We hypothesized that decrease in a modified BODE (mBODE) would predict survival in National Emphysema Treatment Trial (NETT) patients. Objectives: To determine how the mBODE score changes in patients with lung volume reduction surgery versus medical therapy and correlations with survival. Methods: Clinical data were recorded using standardized instruments. The mBODE was calculated and patient-specific mBODE trajectories during 6, 12, and 24 months of follow-up were estimated using separate regressions for each patient. Patients were classified as having decreasing, stable, increasing, or missing mBODE based on their absolute change from baseline. The predictive ability of mBODE change on survival was assessed using multivariate Cox regression models. The index of concordance was used to directly compare the predictive ability of mBODE and its separate components. Measurements and Main Results: The entire cohort (610 treated medically and 608 treated surgically) was characterized by severe airflow obstruction, moderate breathlessness, and increased mBODE at baseline. A wide distribution of change in mBODE was seen at follow-up. An increase in mBODE of more than 1 point was associated with increased mortality in surgically and medically treated patients. Surgically treated patients were less likely to experience death or an increase greater than 1 in mBODE. Indices of concordance showed that mBODE change predicted survival better than its separate components. Conclusions: The mBODE demonstrates short- and intermediate-term responsiveness to intervention in severe chronic obstructive pulmonary disease. Increase in mBODE of more than 1 point from baseline to 6, 12, and 24 months of follow-up was predictive of subsequent mortality. Change in mBODE may prove a good surrogate measure of survival in therapeutic trials in severe chronic obstructive pulmonary disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00000606).",
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author = "Martinez, {Fernando J.} and Han, {MeiLan K.} and Andrei, {Adin Cristian} and Robert Wise and Susan Murray and Curtis, {Jeffrey L.} and Alice Sternberg and Gerard Criner and Gay, {Steven E.} and John Reilly and Barry Make and Ries, {Andrew L.} and Frank Sciurba and Gail Weinmann and Zab Mosenifar and Malcolm DeCamp and Fishman, {Alfred P.} and Celli, {Bartolome R.}",
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Martinez, FJ, Han, MK, Andrei, AC, Wise, R, Murray, S, Curtis, JL, Sternberg, A, Criner, G, Gay, SE, Reilly, J, Make, B, Ries, AL, Sciurba, F, Weinmann, G, Mosenifar, Z, DeCamp, M, Fishman, AP & Celli, BR 2008, 'Longitudinal change in the BODE index predicts mortality in severe emphysema', American journal of respiratory and critical care medicine, vol. 178, no. 5, pp. 491-499. https://doi.org/10.1164/rccm.200709-1383OC

Longitudinal change in the BODE index predicts mortality in severe emphysema. / Martinez, Fernando J.; Han, MeiLan K.; Andrei, Adin Cristian; Wise, Robert; Murray, Susan; Curtis, Jeffrey L.; Sternberg, Alice; Criner, Gerard; Gay, Steven E.; Reilly, John; Make, Barry; Ries, Andrew L.; Sciurba, Frank; Weinmann, Gail; Mosenifar, Zab; DeCamp, Malcolm; Fishman, Alfred P.; Celli, Bartolome R.

In: American journal of respiratory and critical care medicine, Vol. 178, No. 5, 01.09.2008, p. 491-499.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Longitudinal change in the BODE index predicts mortality in severe emphysema

AU - Martinez, Fernando J.

AU - Han, MeiLan K.

AU - Andrei, Adin Cristian

AU - Wise, Robert

AU - Murray, Susan

AU - Curtis, Jeffrey L.

AU - Sternberg, Alice

AU - Criner, Gerard

AU - Gay, Steven E.

AU - Reilly, John

AU - Make, Barry

AU - Ries, Andrew L.

AU - Sciurba, Frank

AU - Weinmann, Gail

AU - Mosenifar, Zab

AU - DeCamp, Malcolm

AU - Fishman, Alfred P.

AU - Celli, Bartolome R.

PY - 2008/9/1

Y1 - 2008/9/1

N2 - Rationale: The predictive value of longitudinal change in BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index has received limited attention. We hypothesized that decrease in a modified BODE (mBODE) would predict survival in National Emphysema Treatment Trial (NETT) patients. Objectives: To determine how the mBODE score changes in patients with lung volume reduction surgery versus medical therapy and correlations with survival. Methods: Clinical data were recorded using standardized instruments. The mBODE was calculated and patient-specific mBODE trajectories during 6, 12, and 24 months of follow-up were estimated using separate regressions for each patient. Patients were classified as having decreasing, stable, increasing, or missing mBODE based on their absolute change from baseline. The predictive ability of mBODE change on survival was assessed using multivariate Cox regression models. The index of concordance was used to directly compare the predictive ability of mBODE and its separate components. Measurements and Main Results: The entire cohort (610 treated medically and 608 treated surgically) was characterized by severe airflow obstruction, moderate breathlessness, and increased mBODE at baseline. A wide distribution of change in mBODE was seen at follow-up. An increase in mBODE of more than 1 point was associated with increased mortality in surgically and medically treated patients. Surgically treated patients were less likely to experience death or an increase greater than 1 in mBODE. Indices of concordance showed that mBODE change predicted survival better than its separate components. Conclusions: The mBODE demonstrates short- and intermediate-term responsiveness to intervention in severe chronic obstructive pulmonary disease. Increase in mBODE of more than 1 point from baseline to 6, 12, and 24 months of follow-up was predictive of subsequent mortality. Change in mBODE may prove a good surrogate measure of survival in therapeutic trials in severe chronic obstructive pulmonary disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00000606).

AB - Rationale: The predictive value of longitudinal change in BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index has received limited attention. We hypothesized that decrease in a modified BODE (mBODE) would predict survival in National Emphysema Treatment Trial (NETT) patients. Objectives: To determine how the mBODE score changes in patients with lung volume reduction surgery versus medical therapy and correlations with survival. Methods: Clinical data were recorded using standardized instruments. The mBODE was calculated and patient-specific mBODE trajectories during 6, 12, and 24 months of follow-up were estimated using separate regressions for each patient. Patients were classified as having decreasing, stable, increasing, or missing mBODE based on their absolute change from baseline. The predictive ability of mBODE change on survival was assessed using multivariate Cox regression models. The index of concordance was used to directly compare the predictive ability of mBODE and its separate components. Measurements and Main Results: The entire cohort (610 treated medically and 608 treated surgically) was characterized by severe airflow obstruction, moderate breathlessness, and increased mBODE at baseline. A wide distribution of change in mBODE was seen at follow-up. An increase in mBODE of more than 1 point was associated with increased mortality in surgically and medically treated patients. Surgically treated patients were less likely to experience death or an increase greater than 1 in mBODE. Indices of concordance showed that mBODE change predicted survival better than its separate components. Conclusions: The mBODE demonstrates short- and intermediate-term responsiveness to intervention in severe chronic obstructive pulmonary disease. Increase in mBODE of more than 1 point from baseline to 6, 12, and 24 months of follow-up was predictive of subsequent mortality. Change in mBODE may prove a good surrogate measure of survival in therapeutic trials in severe chronic obstructive pulmonary disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00000606).

KW - Chronic obstructive pulmonary disease

KW - Multi-dimensional index

KW - Survival

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