The BODE index as a tool to predict survival in COPD lung transplant candidates
- E. Marchand
- Service de Pneumologie, Université Catholique de Louvain, Cliniques Universitaires UCL de Mont-Godinne, Yvoir, Belgium
- E. Marchand, Service de Pneumologie, Université Catholique de Louvain, Cliniques Universitaires UCL de Mont-Godinne, 5530 Yvoir, Belgium. E-mail: eric.marchand{at}uclouvain.be
To the Editors:
Lahzami et al. 1 state that lung transplantation conferred a significant survival benefit in their cohort of patients undergoing the procedure for chronic obstructive pulmonary disease (COPD). They came to this conclusion by comparing observed post-transplant survival with predicted survival derived from the body mass index, airflow obstruction, dyspnoea and exercise capacity (BODE) index. They also suggest that the benefit was possibly underestimated due to a limited follow-up time.
Unfortunately, the authors do not discuss an important limitation. The BODE index, as described by Celli et al. 2, was assessed in a population that differed in at least two important characteristics from the transplanted cohort of Lahzami et al. 1. The first is the mean age (55 yrs for transplanted subjects versus >65 yrs in the original paper by Celli et al. 2). The second is the smoking status, as current smokers are denied lung transplantation, but current smoking was not an exclusion criterion for the study by Celli et al. 2.
Since age 3, 4 and smoking status 5 are two important factors predicting survival in COPD patients, it is hazardous to use the BODE index to compare observed and predicted mortality, as the authors did, since there is a potential for an underestimation of the predicted survival derived from the BODE index in this particular subset of COPD patients.
This obviously does not prevent the BODE index from being useful in the assessment of COPD candidates for lung transplantation.
Footnotes
Statement of Interest
None declared.
- ©ERS 2010