Robert M Reed1, Howard J Cabral2, Mark T Dransfield3, Michael Eberlein4, Christian A Merlo5, Matthew J Mulligan6, Giora Netzer7, Pablo G Sanchez8, Steven M Scharf7, Don D Sin9, Bartholome R Celli10. 1. University of Maryland School of Medicine, Baltimore, MD. Electronic address: rreed@som.umaryland.edu. 2. Boston University School of Public Health, Boston, MA. 3. University of Alabama School of Medicine, Birmingham, AL. 4. University of Iowa School of Medicine, Iowa City, IA. 5. Johns Hopkins University School of Medicine, Baltimore, MD. 6. University of Utah School of Medicine, Salt Lake City, UT. 7. University of Maryland School of Medicine, Baltimore, MD. 8. University of Pittsburgh School of Medicine, Pittsburgh, PA. 9. University of British Columbia Respiratory Medicine, Vancouver, BC, Canada. 10. Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Abstract
BACKGROUND: The BMI, obstruction, dyspnea, and exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for COPD, but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized that patients with COPD who are selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate. METHODS: We performed a retrospective analysis of survival according to the BODE score for patients with COPD in the United Network of Organ Sharing (UNOS) database of lung transplantation candidates (n = 4,377) compared with the cohort of patients with COPD in which the BODE score was validated (n = 625). RESULTS: Median survival in the fourth quartile of BODE score was 59 months (95% CI, 51-77 months) in the UNOS cohort and 37 months (95% CI, 29-42 months) in the BODE validation cohort. In models controlling for BODE score and incorporating lung transplantation as a competing end point, the risk of death was higher in the BODE validation cohort (subhazard ratio, 4.8; 95% CI, 4.0-5.7; P < .001). The risk difference was greatest in the fourth quartile of BODE scores (SHR, 6.1; 95% CI, 4.9-7.6; P < .001). CONCLUSIONS: Extrapolation of prognosis based on the BODE score overestimates mortality risk in lung transplantation candidates with COPD. This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplantation evaluation screening process. Published by Elsevier Inc.
BACKGROUND: The BMI, obstruction, dyspnea, and exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for COPD, but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized that patients with COPD who are selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate. METHODS: We performed a retrospective analysis of survival according to the BODE score for patients with COPD in the United Network of Organ Sharing (UNOS) database of lung transplantation candidates (n = 4,377) compared with the cohort of patients with COPD in which the BODE score was validated (n = 625). RESULTS: Median survival in the fourth quartile of BODE score was 59 months (95% CI, 51-77 months) in the UNOS cohort and 37 months (95% CI, 29-42 months) in the BODE validation cohort. In models controlling for BODE score and incorporating lung transplantation as a competing end point, the risk of death was higher in the BODE validation cohort (subhazard ratio, 4.8; 95% CI, 4.0-5.7; P < .001). The risk difference was greatest in the fourth quartile of BODE scores (SHR, 6.1; 95% CI, 4.9-7.6; P < .001). CONCLUSIONS: Extrapolation of prognosis based on the BODE score overestimates mortality risk in lung transplantation candidates with COPD. This is likely due to a lower prevalence of comorbid conditions attributable to the lung transplantation evaluation screening process. Published by Elsevier Inc.
Authors: Jonathan B Orens; Marc Estenne; Selim Arcasoy; John V Conte; Paul Corris; Jim J Egan; Thomas Egan; Shaf Keshavjee; Christiane Knoop; Robert Kotloff; Fernando J Martinez; Steven Nathan; Scott Palmer; Alec Patterson; Lianne Singer; Gregory Snell; Sean Studer; J L Vachiery; Allan R Glanville Journal: J Heart Lung Transplant Date: 2006-07 Impact factor: 10.247
Authors: Jason D Christie; Leah B Edwards; Anna Y Kucheryavaya; Christian Benden; Anne I Dipchand; Fabienne Dobbels; Richard Kirk; Axel O Rahmel; Josef Stehlik; Marshall I Hertz Journal: J Heart Lung Transplant Date: 2012-10 Impact factor: 10.247
Authors: David Weill; Christian Benden; Paul A Corris; John H Dark; R Duane Davis; Shaf Keshavjee; David J Lederer; Michael J Mulligan; G Alexander Patterson; Lianne G Singer; Greg I Snell; Geert M Verleden; Martin R Zamora; Allan R Glanville Journal: J Heart Lung Transplant Date: 2014-06-26 Impact factor: 10.247
Authors: Roger D Yusen; Leah B Edwards; Anna Y Kucheryavaya; Christian Benden; Anne I Dipchand; Fabienne Dobbels; Samuel B Goldfarb; Bronwyn J Levvey; Lars H Lund; Bruno Meiser; Josef Stehlik Journal: J Heart Lung Transplant Date: 2014-08-14 Impact factor: 10.247
Authors: S Lahzami; P O Bridevaux; P M Soccal; J Wellinger; J H Robert; H B Ris; J D Aubert Journal: Eur Respir J Date: 2009-12-08 Impact factor: 16.671
Authors: Peter M A Calverley; Julie A Anderson; Bartolome Celli; Gary T Ferguson; Christine Jenkins; Paul W Jones; Julie C Yates; Jørgen Vestbo Journal: N Engl J Med Date: 2007-02-22 Impact factor: 91.245
Authors: Sumeet S Chugh; Jonathan Jui; Karen Gunson; Eric C Stecker; Benjamin T John; Barbara Thompson; Nasreen Ilias; Catherine Vickers; Vivek Dogra; Mohamud Daya; Jack Kron; Zhi-Jie Zheng; George Mensah; John McAnulty Journal: J Am Coll Cardiol Date: 2004-09-15 Impact factor: 24.094
Authors: Robert M Reed; Michael Eberlein; Reda E Girgis; Salman Hashmi; Aldo Iacono; Steven Jones; Giora Netzer; Steven Scharf Journal: Am J Med Date: 2012-09-06 Impact factor: 4.965
Authors: Nicholas R Anthonisen; John E Connett; Paul L Enright; Jure Manfreda Journal: Am J Respir Crit Care Med Date: 2002-08-01 Impact factor: 21.405
Authors: Lorriana E Leard; Are M Holm; Maryam Valapour; Allan R Glanville; Sandeep Attawar; Meghan Aversa; Silvia V Campos; Lillian M Christon; Marcelo Cypel; Göran Dellgren; Matthew G Hartwig; Siddhartha G Kapnadak; Nicholas A Kolaitis; Robert M Kotloff; Caroline M Patterson; Oksana A Shlobin; Patrick J Smith; Amparo Solé; Melinda Solomon; David Weill; Marlies S Wijsenbeek; Brigitte W M Willemse; Selim M Arcasoy; Kathleen J Ramos Journal: J Heart Lung Transplant Date: 2021-07-24 Impact factor: 13.569
Authors: Javier de Miguel-Díez; Ana López-de-Andres; Valentín Hernández-Barrera; José M de Miguel-Yanes; Manuel Méndez-Bailón; Rodrigo Jiménez-García Journal: Int J Chron Obstruct Pulmon Dis Date: 2019-03-27
Authors: Andrew W Murray; Michael L Boisen; Ashley Fritz; J Ross Renew; Archer Kilbourne Martin Journal: J Thorac Dis Date: 2021-11 Impact factor: 2.895