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