Obstructive Lung Diseases |

Prognostication in Patients With Chronic Obstructive Pulmonary Disease Using the BOS Index FREE TO VIEW

Hiang Ping Chan; Amartya Mukhopadhyay; Pauline Chong; Sally Chin; Xue Yun Wong; Venetia Ong; Yiong Huak Chan; Tow Keang Lim; Jason Phua
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National University Health System, Singapore, Singapore

Chest. 2015;148(4_MeetingAbstracts):683A. doi:10.1378/chest.2225059
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SESSION TITLE: COPD Poster Discussion

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Sunday, October 25, 2015 at 01:30 PM - 03:00 PM

PURPOSE: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality worldwide. Many multidimensional tools such as the GOLD 2011 classification, St George’s Respiratory Questionnaire (SGRQ), and the Body mass index (BMI), Obstruction, Dyspnoea, Exercise (BODE) index have been assessed for their prognostic utility in COPD patients. We aim to evaluate the prognostic utility of the BMI, Obstruction and SGRQ (BOS) index. The BOS index is similar to the BODE index but without the 6-minute walk component and with SGRQ replacing the mMRC scores.

METHODS: This is a prospective study involving 1072 patients who were followed between March 2008 and March 2013. They were classified into BOS quartiles according to their scores: Group 1: BOS 0-2; Group 2: BOS 3-4; Group 3: BOS 5; Group 4: BOS 6-7. Outcomes measures were exacerbations and mortality. Multivariable time-to-event analyses (adjusting for age, gender and race) and receiver operator characteristics (ROC) curve were used.

RESULTS: Of the 1072 patients, 285 were in Group 1, 404 in Group 2, 186 in Group 3 and 197 in Group 4. Patients in Group 4 had earlier exacerbations compared to those in Group 1 (HR 0.48, 95% CI 0.36-0.65, p<0.001) and 2 (HR 0.65, 95% CI 0.50-0.84, p=0.001) but not Group 3 (HR 1.03, 95% CI 0.77-1.37, p=0.855). Group 4 also had shorter time to death compared to Group 1 (HR 0.26, 95% CI 0.16-0.42, p<0.001) and 2 (HR 0.54, 95% CI 0.39-0.77, p<0.001) but not Group 3 (HR 0.71, 95% CI 0.64-1.34, p=0.709). Areas under ROC curves (AUC) were 0.62±0.02 and 0.71±0.02 for exacerbation and mortality respectively. These were identical to AUCs obtained when patients were classified according to GOLD 2011.

CONCLUSIONS: BOS index predicts exacerbation and mortality moderately well. It has similar prognostic utility as the GOLD 2011 classification.

CLINICAL IMPLICATIONS: BOS index can be used for prognostication. Patients in Group 3 and 4 will have worse outcomes compared to their counterparts in the less severe groups.

DISCLOSURE: The following authors have nothing to disclose: Hiang Ping Chan, Amartya Mukhopadhyay, Pauline Chong, Sally Chin, Xue Yun Wong, Venetia Ong, Yiong Huak Chan, Tow Keang Lim, Jason Phua

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