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Evaluation of BODE index and its relationship with systemic inflammation mediated by proinflammatory biomarkers in patients with COPD

Authors Khan NA, Daga MK, Ahmad I, Mawari G, Kumar S, Kumar N, Husain SA

Received 18 March 2016

Accepted for publication 21 June 2016

Published 18 November 2016 Volume 2016:9 Pages 187—198

DOI https://doi.org/10.2147/JIR.S108783

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 4

Editor who approved publication: Dr Ning Quan


Naushad Ahmad Khan,1,2 Mradul Kumar Daga,1 Istaq Ahmad,2 Govind Mawari,1 Suman Kumar,3 Naresh Kumar,1 Syed Akhter Husain2

1Department of Medicine, Maulana Azad Medical College, 2Department of Biosciences, Jamia Millia Islamia, 3Department of Microbiology, Maulana Azad Medical College, New Delhi, India


Introduction: BODE index, a multidimensional grading system which is based on Body mass index, airway Obstruction, Dyspnea scale, and Exercise capacity, has been increasingly used for the evaluation of chronic obstructive pulmonary disease (COPD). Many of the systemic manifestations of COPD are shown to be mediated by elevated levels of proinflammatory biomarkers.
Objective: We aimed to investigate the relationship between the BODE index, its components, disease severity, and proinflammatory biomarkers like C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6.
Materials and methods: A cross-sectional study which included 290 clinically stable COPD patients and 80 smoker controls was conducted. Medical history, body mass index, pulmonary function tests, 6-minute walking test, and modified scale of Medical Research Council dyspnea scale were evaluated. BODE scores were determined. Systemic inflammation was evaluated with the measurement of CRP, TNF-α, and IL-6 in the serum samples of all studied subjects. The correlation between inflammatory biomarkers and BODE index was assessed in COPD patients.
Results: We found a significant relationship between COPD stages and BODE index. Our analysis showed significant association between systemic biomarkers and components of the BODE index. Both TNF-α and CRP levels exhibited weak but significant correlation with BODE index. Serum IL-6 concentrations exhibited significant correlation with 6-minute walking test, modified scale of Medical Research Council, and BODE index (r=0.201, P=0.004; r=0.068, P=0.001; and r=0.530, P=0.001, respectively). Also, an inverse and significant correlation was observed between BODE index and FEV1 (r=0.567, P=0.001). IL-6 exhibited a highly significant and inverse correlation with FEV1 (r=−0.580, P=0.001).
Conclusion: BODE index should be considered for evaluating patients with COPD. Also, IL-6 seems to be a potential biomarker that may enable determination of the severity and prediction of the course of the disease.

Keywords: BODE index, chronic obstructive pulmonary disease, systemic inflammation, biomarkers

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