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Multidimensional system for assessment of COPD patients. Comparison with BODE index
Stefan S Kostianev1, Vladimir A Hodgev, Dimitar H Iluchev
1Department of Pathophysiology, Medical University, Plovdiv, Bulgaria.
Aim:
To present the principles of a multidimensional system for assessment of COPD patients, called DOREMI BOX, and to compare it with BODE index. The letters of the abbreviation stand for the following: D--dyspnea, O--obstruction, RE--rate of exacerbation, MI--movement (exercise) intolerance, B--Body Mass Index, OX--blood oxygen disturbances.
Methods:
For validation of DOREMI BOX we tested 84 patients with COPD (age = 59 +/- 9 years, FEV1% = 35 +/- 14%; Charlson index = 2.7 +/- 1.0) in clinically stable condition. The prognostic value of the new system was validated prospectively in a cohort of 68 COPD patients followed-up for a minimum of 36 months.
Results:
The mean value of DOREMI BOX score was 6.0 +/- 1.8 (range = 3-10), and for BODE index--4.7 +/- 2.2 (range = 1-10). Construct validity has been demonstrated between DOREMI BOX score and symptoms score (R=0.52; P<0.001). DOREMI BOX score correlates strongly with the classic indices for assessment and staging of COPD--FEV1%, dyspneic scales, blood gases, 6MWD, which proves its concurrent validity. After 36 months there were 22 deaths and 46 survivals. Patients with higher DOREMI BOX score were at a higher risk of death. The hazard ratio for death from any cause per one-point increase in the DOREMI BOX score was 1.44 (95% CI, 1.06-1.95; P=0.009).
Conclusions:
DOREMI BOX has construct and concurrent validity for assessment of COPD and slightly better ability than BODE index to predict risk for death in COPD patients.
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