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Introducing a new prognostic instrument for long-term mortality prediction in COPD patients: the CADOT index
Kristian Brat1,2, Michal Svoboda3,2, Karel Hejduk2
1Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic.
Insights
A new COPD mortality prediction tool, CADOT, was developed. It incorporates chronic heart failure and TLCO, offering a complementary alternative to existing BODE and ADO indices for better clinical prognosis.
Area of Science:
- Pulmonary Medicine
- Cardiopulmonary Research
- Clinical Prognostics
Background:
- Existing COPD prognosis tools like BODE and ADO have limitations in daily clinical practice.
- Accurate mortality prediction is crucial for managing COPD patients.
- There is a need for complementary prognostic instruments in COPD management.
Purpose of the Study:
- To develop a novel prognostic instrument for COPD patients.
- To overcome limitations of current prognostic tools (BODE, ADO).
- To provide a complementary tool for clinical use in COPD mortality prediction.
Main Methods:
- Data from 699 COPD patients (Czech Republic) were analyzed to identify mortality risk factors.
- ROC and reclassification analyses were used to select key prognostic factors.
- A new index, CADOT, was constructed and validated on 187 COPD patients (Netherlands).
Main Results:
- The CADOT index was developed by adding chronic heart failure (CHF) and TLCO to the ADO index.
- CADOT demonstrated superior c-statistic values compared to BODE and ADO in the derivation cohort (0.701 vs 0.677 vs 0.644).
- CADOT showed strong prognostic power in the validation cohort (0.842 vs 0.799 vs 0.825).
Conclusions:
- The CADOT index offers comparable prognostic power to BODE and ADO for COPD mortality.
- CADOT serves as a complementary or alternative tool, especially when 6-MWT is not feasible or for reduced age dependence.
- This new index enhances prognostic assessment in COPD clinical practice.
Objectives:
The BODE (BMI, Obstruction - FEV1, Dyspnoea - mMRC, Exercise - 6-MWT) and the ADO (Age, Dyspnoea - mMRC, Obstruction - FEV1) 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 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).
Results:
The CADOT was constructed by adding two newly identified prognosis-determining factors, chronic heart failure (CHF) and TLCO, 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).
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