Abstract
BACKGROUND: Severe exacerbations are a significant predictor of poor prognosis and mortality in patients with chronic obstructive pulmonary disease (COPD). Multidimensional indices, such as the BODE (BMI, airflow obstruction, dyspnea, and exercise capacity) and ADO indices (age, dyspnea severity, and airflow obstruction), outperform single-variable assessments in predicting survival. However, anemia, a strong predictor of mortality in both the general population and COPD patients, has not been included in the prediction indices. This study aimed to evaluate whether including anemia as a variable enhances the predictive accuracy of these indices for both short-term and long-term mortality in COPD patients. METHODS: Data from patients who were consecutively admitted for acute exacerbation of COPD were recorded with a minimum follow-up of three years. Patients were divided into two groups: anemic (Hb <12 g/dL in women and Hb <13 g/dL in men) or non-anemic. Modified versions of the BODEx (BMI, airflow obstruction, dyspnea, and exacerbation) and ADO indices that included anemia, termed BODEx-A3 and ADO-A3, were created by adding three points to the original values. RESULTS: A total of 141 patients were included. Twenty-one (15%) died during the first year after admission, and 48 (34%) died during the three-year follow-up period. The area under the receiver operating characteristic curve (AUC) for predicting one-year mortality was slightly higher with the BODEx-A3 compared to the BODEx (0.83 vs. 0.78) and with the ADO-A3 compared to the ADO (0.81 vs. 0.78). For three-year mortality, the predictive power of the BODEx-A3 (AUC 0.77 vs. 0.67 for BODEx, p<0.001) and ADO-A3 indices (AUC 0.82 vs. 0.77 for ADO, p=0.038) was significantly greater compared to their original versions. CONCLUSION: We have defined novel multidimensional indices (BODEx-A3 and ADO-A3) for predicting short- and long-term mortality in patients hospitalized with COPD exacerbation. These indices were derived by adding three points to the standard BODEx and ADO scores in anemic patients. Our findings demonstrate that incorporating anemia into the best existing COPD mortality predictor indices significantly improves their predictive capacity.