Prognostic assessment in COPD without lung function: the B-AE-D indices

Lucas Boeck, Joan B. Soriano, Marjolein Brusse-Keizer, Francesco Blasi, Konstantinos Kostikas, Wim Boersma, Branislava Milenkovic, Renaud Louis, Alicia Lacoma, Remco Djamin, Joachim Aerts, Antoni Torres, Gernot Rohde, Tobias Welte, Pablo Martinez-Camblor, Janko Rakic, Andreas Scherr, Michael Koller, Job van der Palen, Jose M. MarinInmaculada Alfageme, Pere Almagro, Ciro Casanova, Cristobal Esteban, Juan J. Soler-Cataluna, Juan P. de-Torres, Marc Miravitlles, Bartolome R. Celli, Michael Tamm, Daiana Stolz*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function. The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988). Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer-Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer-Lemeshow test all p>0.05). The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk.
Original languageEnglish
Pages (from-to)1635-1644
JournalEuropean Respiratory Journal
Issue number6
Publication statusPublished - Jun 2016


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