Comparison of Global Initiative for Chronic Obstructive Pulmonary Disease 2013 Classification and Body Mass Index, Airflow Obstruction, Dyspnea, and Exacerbations Index in Predicting Mortality and Exacerbations in Elderly Adults with Chronic Obstructive Pulmonary Disease

Objectives To examine whether the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 2013 revision offers greater predictive ability than the body mass index, airflow obstruction, dyspnea, and exacerbations (BODEx) index in elderly adults with chronic obstructive pulmonary disease (C...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2015-02, Vol.63 (2), p.244-250
Main Authors: Chen, Chiung-Zuei, Ou, Chih-Ying, Yu, Chun-Hsiang, Yang, Szu-Chun, Chang, Han-Yu, Hsiue, Tzuen-Ren
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
BODEx
Body Mass Index
Chronic obstructive pulmonary disease
Cohort Studies
Disease Progression
Dyspnea - etiology
Dyspnea - mortality
Dyspnea - physiopathology
elderly adults
exacerbations
Female
Forced Expiratory Volume
Geriatrics
Health Status Indicators
Humans
Male
Mortality
Predictive Value of Tests
Pulmonary Disease, Chronic Obstructive - complications
Pulmonary Disease, Chronic Obstructive - mortality
Pulmonary Disease, Chronic Obstructive - physiopathology
Risk Factors
Taiwan
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Summary:Objectives To examine whether the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 2013 revision offers greater predictive ability than the body mass index, airflow obstruction, dyspnea, and exacerbations (BODEx) index in elderly adults with chronic obstructive pulmonary disease (COPD). Design Prospective cohort study. Setting University‐affiliated medical center. Participants Taiwanese outpatients with COPD (N = 354). Measurements Participants were classified as Group A (low risk with mild dyspnea), Group B (low risk with more‐severe dyspnea), Group C (high risk with mild dyspnea), and Group D (high risk with more‐severe dyspnea) for GOLD 2013 and from Quartile 1 (0–2 points) to 4 (7–9 points) for BODEx score. Ability to predict exacerbations and mortality was compared using logistic regression analysis with receiver operating characteristic (ROC) curve estimations and area under the ROC curve (AUC). Results Mortality was 14.1% for GOLD Group A, 14.5% for Group B, 6.5% for Group C, and 35.8% for Group D and 15.2% for BODEx Quartile 1, 22.5% for Quartile 2, 28.1% for Quartile 3, and 79.2% for Quartile 4. Risk of exacerbation relative to Group A was 1.7 (95% confidence interval (CI) = 0.6–4.3) for Group B, 14.1 (95% CI = 4.6–43.2) for Group C, and 17.9 (95% CI = 7.6–42.0) for Group D. The AUC for the GOLD classification and BODEx index were 0.65 and 0.67 for mortality (P = .60) and 0.79 and 0.73 for exacerbation (P = .03). Conclusion The GOLD 2013 classification performed well in identifying individuals at risk of exacerbations, and its predictive ability for exacerbations was better than that of the BODEx index, although the predictive ability for mortality in elderly adults with COPD was poor for both indices.
ISSN:0002-8614
1532-5415
DOI:10.1111/jgs.13258