CORRELATION OF BODE INDEX WITH SMOKING INDEX, HOSPITAL STAY, CARDIAC INVOLVEMENT, AND NUTRITIONAL STATUS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A CASE CONTROL STUDY IN PREDICTION OF THE DISEASE SEVERITY

Abstract

Background. Chronic Obstructive Pulmonary Disease (COPD) affects such a wide range of population, extending the reach of healthcare facilities and ensuring COPD control is an immense challenge. There is a need of a logical and reliable scoring system which can identify population who need diagnostic or therapeutic assistance but they can't afford it because of a health-care budget crisis. Aim. Current study aimed to correlate the BODE index of chronic obstructive pulmonary disease with the smoking index, hospital stay, cardiac involvement, nutritional status, and systemic inflammation. Materials and Methods. 40 Patients with COPD symptoms were enrolled as cases and age matched 40 healthy subjects without any COPD were enrolled as control subjects. BMI, FEV1, distance walked in 6 minutes, and the MMRC dyspnea scale were used to generate the BODE index, and ECHO cardiograph was performed. Correlation assessed between Bode index severity and BMI, hospitalization stay, serum albumin, Hemoglobin, CRP levels, QRS axis by electrocardiography, ejection fraction and pulmonary hypertension by 2D EHCO. Results: Totally 9 patients had mild COPD with a BODE score between 0 to 2, while 17 patients had moderate COPD with BODE score between 3 to 5, and 14 patients had severe COPD with BODE score of ≥ 6. Mild COPD cases had 10 pack years, moderate cases had 19 pack years, and severe cases had 29 pack years of smoke, and the number of pack years of smoking was significantly associated with the BODE score (P = 0.01). The mean length of hospital stay in the moderate COPD group was 6±1.5 days, and 19±1.6 days in the severe COPD group. Significant association observed between severity and hospital stay (p=0.004). Hemoglobin levels were lower as per disease severity (11.4 ±1.29 vs 9.5± 1.8 vs 10.62 ±2.5 in mild, moderate, severe COPD (P=0.04). Majority of COPD cases had a right axis deviation (RAD), 86.67% (n=13) of severe COPD cases and 35.3% (n=6) of moderate COPD cases had RAD. The mean ejection fraction was lower in severe COPD when compared to moderate and mild COPD with significant association (48.1±7.8% vs 69.5 ± 8.2% vs 65.6 ± 5.9%, P=0.032). There was a positive correlation observed between COPD severity and CRP levels. The changes in BMI and serum albumin can be attributed to reduction in nutritional status of COPD patients, which is directly correlated with BODE index. Severe COPD cases exhibits higher CRP levels of 65.2±52.9 than compared with mild COPD cases with CRP of 26.5±19.5 mg/L. Statistically significant association noted between severity of disease and CRP levels (p=0.0045). 10 cases in severe COPD group had pulmonary hypertension and 2 patients had mild pulmonary hypertension, and 2 cases had moderate pulmonary hypertension. There was significant association observed between COPD severity and pulmonary hypertension severity (P=0.015). Conclusion: The BODE index is a valid tool to determine the severity of COPD and it is directly associated with the smoking index. An increase in cardiac effects with the severity of COPD disease was observed when it was assessed by BODE index. Current study suggests that the BODE index is reliable in determining the hospitalization and severity of systemic involvement in COPD patients and not only an indicator of mortality.