PT  - JOURNAL ARTICLE
AU  - Daiana Stolz
AU  - Kostantinos Kostikas
AU  - Francesco Blasi
AU  - Wim Boersma
AU  - Branislava Milenkovic
AU  - Alicia Lacoma
AU  - Renaud Louis
AU  - Joachim G. Aerts
AU  - Tobias Welte
AU  - Antoni Torres
AU  - Gernot G.U. Rohde
AU  - Lucas Boeck
AU  - Janko Rakic
AU  - Andreas Scherr
AU  - Sabine Hertel
AU  - Sven Giersdorf
AU  - Michael Tamm
TI  - Adrenomedullin refines mortality prediction by the BODE index in COPD: the “BODE-A” index
AID  - 10.1183/09031936.00058713
DP  - 2014 Feb 01
TA  - European Respiratory Journal
PG  - 397--408
VI  - 43
IP  - 2
4099  - http://erj.ersjournals.com/content/43/2/397.short
4100  - http://erj.ersjournals.com/content/43/2/397.full
SO  - Eur Respir J2014 Feb 01; 43
AB  - 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. Pro-adrenomedullin improves BODE prediction of mortality in COPD patients and may substitute for 6-min walk distance http://ow.ly/qV5M3