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Adrenomedullin refines mortality prediction by the BODE index in COPD: the "BODE-A" index.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Stolz Daiana, Kostikas Kostantinos, Blasi Francesco, Boersma Wim, Milenkovic Branislava, Lacoma Alicia, Louis Renaud, Aerts Joachim G, Welte Tobias, Torres Antoni, Rohde Gernot G U, Boeck Lucas, Rakic Janko, Scherr Andreas, Hertel Sabine, Giersdorf Sven, Tamm Michael,
Project Preventing viral exacerbation of chronic obstructive pulmonary disease in upper respiratory tract infection - The PREVENT study
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Original article (peer-reviewed)

Journal The European respiratory journal
Volume (Issue) 43(2)
Page(s) 397 - 408
Title of proceedings The European respiratory journal
DOI 10.1183/09031936.00058713

Abstract

The BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index is well-validated for mortality prediction in chronic obstructive pulmonary disease (COPD). Concentrations of plasma pro-adrenomedullin, a surrogate for mature adrenomedullin, independently predicted 2-year mortality among inpatients with COPD exacerbation. We compared accuracy of initial pro-adrenomedullin level, BODE and BODE components, alone or combined, in predicting 1-year or 2-year all-cause mortality in a multicentre, multinational observational cohort with stable, moderate to very severe COPD. Pro-adrenomedullin was significantly associated (p<0.001) with 1-year mortality (4.7%) and 2-year mortality (7.8%) and comparably predictive to BODE regarding both (C statistics 0.691 versus 0.745 and 0.635 versus 0.679, respectively). Relative to using BODE alone, adding pro-adrenomedullin significantly improved 1-year and 2-year mortality prognostication (C statistics 0.750 and 0.818, respectively; both p<0.001). Pro-adrenomedullin plus BOD was more predictive than the original BODE including 6-min walk distance. In multivariable analysis, pro-adrenomedullin (likelihood ratio Chi-squared 13.0, p<0.001), body mass index (8.5, p=0.004) and 6-min walk distance (7.5, p=0.006) independently foretold 2-year survival, but modified Medical Research Council dyspnoea score (2.2, p=0.14) and forced expiratory volume in 1 s % predicted (0.3, p=0.60) did not. Pro-adrenomedullin plus BODE better predicts mortality in COPD patients than does BODE alone; pro-adrenomedullin may substitute for 6-min walk distance in BODE when 6-min walk testing is unavailable.
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