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

Abstract

Objectives. The BODE (BMI, Obstruction-FEV 1 , Dyspnoea-mMRC, Exercise-6-MWT) and the ADO (Age, Dyspnoea-mMRC, Obstruction-FEV 1) 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 longterm 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).

The Relation Between Clinical Phenotypes, GOLD Groups/Stages and Mortality in COPD Patients – A Prospective Multicenter Study

“…CHF as one of the strongest predictors of death in COPD patients. [31][32][33][34] Prognostic importance of cachexia has been discussed above.…”

Chronic obstructive pulmonary disease: diagnosis and treatment of stable phase of disease; personalized treatment approach using phenotype features of the disease

“…V dnešní době jsou k tomuto účelu používány kompozitní prognostické nástroje -indexy ADO a BODE (35,36). Naše výzkumná skupina zkonstruovala prognostický nástroj CADOT, který předchází některým nevýhodám indexů BODE a ADO a doporučujeme ho k používání v denní praxi (37). (4,5,19,41).…”

Chronic obstructive pulmonary disease - diagnosis and management of stable disease; a personalized approach to care, using the treatable traits concept based on clinical phenotypes. Position paper of the Czech Pneumological and Phthisiological Society

“…The CADOT showed slightly better prognostic properties compared to ADO and BODE indices and prevented the specific problems associated with the use of BODE (ref. 60 ). The CADOT incorporates also chronic heart failure that has strong linkage to mortality risk and also to functional impairment of the lungs 61 .…”

“…The coexistence of COPD and CVD has a negative impact on prognosis 60 . CVD as a comorbidity of COPD includes chronic heart failure (CHF), ischemic heart disease, arrhythmias, atherosclerotic peripheral vascular disease and systemic hypertension.…”