THE RELATIONSHIP BETWEEN BODE INDEX THE RELATIONSHIP BETWEEN BODE INDEX AND QUALITY OF LIFE, CRP, TNF-α, IL-8 AND QUALITY OF LIFE, CRP, TNF-α, IL-8

IN COPD PATIENTSIN COPD PATIENTS

Nurhan SarıoğluNurhan Sarıoğlu*, Aylin Özgen*, Ayşın Şakar Coşkun*, Pınar *, Aylin Özgen*, Ayşın Şakar Coşkun*, Pınar Çelik*, Çelik*,

Beyhan Cengiz Özyurt**, Fatma Taneli***, Arzu Beyhan Cengiz Özyurt**, Fatma Taneli***, Arzu Yorgancıoğlu*Yorgancıoğlu*

*Celal Bayar University School of Medicine, *Celal Bayar University School of Medicine, Departments of Pulmonology*, Departments of Pulmonology*, Public Health**,

Biochemistry***

INTRODUCTIONINTRODUCTION► COPD is a multisystem diseaseCOPD is a multisystem disease► FEVFEV11 is an important parameter of COPD is an important parameter of COPD► FEVFEV11 is known to correlate poorly with is known to correlate poorly with

symptoms,symptoms, quality of life, frequency of exacerbations, andquality of life, frequency of exacerbations, and exercise toleranceexercise tolerance► New functional assesment parameters (BODE)New functional assesment parameters (BODE)

Inflammation markersInflammation markers Quality of life Quality of life

BODEBODE► BBody mass index (kg/m2) ody mass index (kg/m2) ► Airflow Airflow OObstruction (FEVbstruction (FEV1) ) ► DDyspnea (MMRC)yspnea (MMRC)► EExercise capacity (distance walked in 6 xercise capacity (distance walked in 6

min) min)

Variable Points on the BODE index0 1 2 3

Body mass index (kg/m²)

>21 ≤21 - -

FEV1 (% of predicted)

≥65 50-64 36-49 ≤35

Distance walked in 6 min (m)

≥350 250-349 150-249 ≤149

MMRC dyspnea skale (score)

0-1 2 3 4

1-2 points: BODE 02-4 points: BODE 14-7 points: BODE 27-10 points: BODE 3 Celli B. Respir Med 2005 Dec; 99 (B): S41-8

AIMAIM► BODE index BODE index relationship of SGRQ relationship of SGRQ ► BODE indeBODE indexx relationship of inflammation relationship of inflammation

markersmarkers (CRP, TNF(CRP, TNF and IL-8) and IL-8)

MATERIALS AND METHODSMATERIALS AND METHODS

► 103 stable COPD patients (GOLD)103 stable COPD patients (GOLD)► Body mass index Body mass index ► Pulmonary function tests Pulmonary function tests ► MMRC dyspnea scaleMMRC dyspnea scale► Distance walked in 6 min.6 min.► St. George Quality of Life (SGQOL) St. George Quality of Life (SGQOL)

questionnaire questionnaire

MATERIALS AND METHODSMATERIALS AND METHODS

► 103 case, in serum 103 case, in serum ( (turbidymetricturbidymetric) CRP ) CRP levels levels

► 78 case, in serum 78 case, in serum (ELISA): TNF (ELISA): TNF and IL-8 and IL-8 levelslevels► Data analysis: Pearson-correlation,Data analysis: Pearson-correlation, Kruskal-Wallis and Ki-kare tests Kruskal-Wallis and Ki-kare tests

RESULTSRESULTS

05

1015202530354045

(%)

1 2 3 4 Stage

Figure 1. Case distrubition according to stages

RESULTSRESULTS

stage 4-very severeStage 3- severestage 2-moderatestage 1-mild

Stage

Figure 2. The relationship of BODE and stage of COPD

10,00

9,00

8,00

7,00

6,00

5,00

4,00

3,00

BODE points

P valuesBMI MRC Distance

walked in 6 min

FEV1 BODE

Duration ofDisease

0,845 0,001** 0,036* 0,000**

0,013*

Smoking(pack/years)

0,794 0,908 0,808 0,771 0,509

Number ofExacerbations

0,227 0,002* 0,016* 0,000**

0,000**

Number ofhospitalization

0,162 0,000** 0,001** 0,030*r:-0,21

0,000**r: 0,36

*: p < 0,05**: p < 0,001

RESULTSRESULTS

Figure 5. The relationship of FEV1 and number of hospitalization

0

1

2

3

4

0 3 6 9 12 15

FEV1

FEV1

Figure 3. The relationship of FEV1 and duration of disease

0

2

4

0 20 40 60

FEV1

1

Figure 4. The relationship of FEV1 and number of exacerbationss

01234

0 5 10 15 20

number of exacerbations

FEV1

0

5

10

15

20

25

1 2 3 4 5 6 7 8 9 10

BODE

Figure 6. The relationship BODE and duration of disesase, number of exacerbation, hospitalization

number of hospitalization

number of exacerbation

duration of disease

RESULTSRESULTS

0123456789

10

BODE points

24,09 37,5 46,02 51,01 50,62 51,59 54,9 60,46 62,79 89,53

total score of SGRQFigure 7. The relationship of BODE and SGRQ

RESULTSRESULTS

RESULTSRESULTS

0

0,5

1

1,5

2

2,5

3

CRP levels

0 1 2 3 4 5 6 7 8 10BODE points

Figure 8. The relationship of BODE and serum CRP levels

P values

BMI MRC Distancewalked in 6min

FEV1 BODE

CRP 0,150 0,077 0,430 0,165 0,014*

TNF 0,754 0,075 0,975 0,151 0,463

IL-8 0,196 0,442 0,442 0,805 0,834

*: p < 0,05

RESULTSRESULTS

RESULTSRESULTS

010203040506070

SGRQ

<0,5 0,5-1,0 1,0-1,5 1,5-2,5 >2,5 CRP

Figure 9. The relationship of CRP and SGRQ

CRP

SGRQ

DISCUSSIONDISCUSSION► Relationship of BODE and hospital admission is Relationship of BODE and hospital admission is

strongerstronger than FEVthan FEV11

Chest 2005; 128: 3810-3816Chest 2005; 128: 3810-3816

► BODE is a good marker in severity of exacerbations inBODE is a good marker in severity of exacerbations in COPD COPD

Am J Respir Crit Care Med 2003; 167: A23Am J Respir Crit Care Med 2003; 167: A23

DISCUSSIONDISCUSSION► The relationship of BODE and SGRQ scores is The relationship of BODE and SGRQ scores is

moderate to high moderate to high The relationship of severity of COPD and SGRQ The relationship of severity of COPD and SGRQ

scores is poorscores is poor Int J Chron Obstruct Pulmon Dis. 2006; 1(1): Int J Chron Obstruct Pulmon Dis. 2006; 1(1):

91-691-6

► A significant relationship was determined between A significant relationship was determined between serum CRP levels and severity of COPD, BODEserum CRP levels and severity of COPD, BODE

Eur Respir J 2006; 27: 902-907 Eur Respir J 2006; 27: 902-907

CONCLUSIONCONCLUSION

► BODE is a clinical test, reflecting BODE is a clinical test, reflecting multisystemic components of COPD multisystemic components of COPD

► Good relationship with quality of life and Good relationship with quality of life and serum CRP levels serum CRP levels

► More predictive marker than FEVMore predictive marker than FEV11 in hospital in hospital admissions admissions

► In the future we suggest that BODE will In the future we suggest that BODE will replace FEVreplace FEV11 in staging COPD in staging COPD