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

• Published in: Biomedical papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia Vol. 165; no. 2; pp. 139 - 145
• Main Authors: Brat, Kristian, Svoboda, Michal, Hejduk, Karel, Plutinsky, Marek, Zatloukal, Jaromir, Volakova, Eva, Popelkova, Patrice, Novotna, Barbora, Engova, Dita, Franssen, Frits M E, Vanfleteren, Lowie E G W, Spruit, Martijn A, Koblizek, Vladimir
• Format: Journal Article
• Language: English
• Published: Czech Republic Palacký University Olomouc, Faculty of Medicine and Dentistry 01-06-2021
• Subjects: acute exacerbations; bode index; Body Mass Index; Clinical Medicine; COPD; Dyspnea; Engineering; Humans; Klinisk medicin; mortality; Prognosis; prognostic index; pulmonary; Pulmonary Disease, Chronic Obstructive - mortality; pulmonary function; Research & Experimental Medicine; Respiratory Function Tests; Severity of Illness Index; mortality; pulmonary function; prognostic index; COPD
• ISSN: 1213-8118; 1804-7521
• DOI: 10.5507/bp.2020.035

The BODE (BMI, Obstruction - FEV
, Dyspnoea - mMRC, Exercise - 6-MWT) and the ADO (Age, Dyspnoea - mMRC, Obstruction - FEV
) 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.
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).
The CADOT was constructed by adding two newly identified prognosis-determining factors, chronic heart failure (CHF) and TL
, 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).
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.
ClinicalTrials.gov (NCT01923051).