TY - JOUR T1 - Modified BODE Index to Predict Mortality in Individuals With COPD: The Role of 4-Min Step Test JF - Respiratory Care DO - 10.4187/respcare.06991 SP - respcare.06991 AU - Elaine B Vieira AU - Luiza H Degani-Costa AU - Beatriz C Amorim AU - Lígia B Oliveira AU - Talita Miranda-Silva AU - Priscila CA Sperandio AU - Wladimir M Medeiros AU - Flávio F Arbex AU - Roberta P Ramos AU - Luiz E Nery Y1 - 2020/01/28 UR - http://rc.rcjournal.com/content/early/2020/01/07/respcare.06991.abstract N2 - BACKGROUND: The BODE (body mass index, air-flow obstruction, dyspnea, exercise capacity) index is a composite prognostic marker that predicts mortality in COPD. It includes body mass index, air-flow obstruction, dyspnea score, and exercise capacity by using the 6-min walk distance. However, a 30-m-long corridor is necessary to perform the test and this limits its use in clinical practice. Step tests may elicit distinct physiologic responses compared with the 6-min walk test but are easy to perform in the office setting. We sought to investigate whether a 4-min step test would be a suitable surrogate of the 6-min walk test, in a modified BODE step index (simplified BODE index), to predict mortality in COPD.METHODS: Individuals with COPD performed a self-paced 4-min step test, and the simplified BODE index was calculated by replacing the 6-min walk distance by the number of steps climbed. Cutoff values were determined by receiver operating characteristic curve analysis as follows: score 0 for >60 steps; score 1 for 50–60 steps; score 2 for 40–49 steps; and score 3 for <40 steps.RESULTS: A total of 186 individuals with COPD were enrolled from 2011 to 2016 (60% males; mean ± SD age, 65 ± 9 y; mean ± SD FEV1, 50 ± 17 L). There were 36 deaths among the study cohort. The simplified BODE index was a prognostic marker, independent of cardiovascular comorbidities and oxygen desaturation (HR 1.12, confidence interval (CI) [1.03–1.22]). Individuals with simplified BODE index scores ≥ 7 were at higher risk of death from any cause (P < .001, log-rank test).CONCLUSIONS: This was the first study, to our knowledge, to show that the 4-min step test as a surrogate of exercise capacity in the BODE index (simplified BODE index) is an independent predictor of mortality in COPD and may help to spread its use among practicing physicians. ER -