Co esponding au ho : FZ. Elazizi
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Bode index in s able COPD pa ien s a angie uni e si y hospi al
Fa ima Zah a Elazizi 1, 3, *, Soumia Fdil 1, 3, Dalal Zagaouch 1, 3, Khalid Bou i 1, 2, 3 and Sanaa Hammi 1, 2, 3
1 Depa men o Pulmonology, Mohammed VI Uni e si y Hospi al, Tangie , Mo occo.
2 Labo a o y o Li e and Heal h Sciences.
3 Facul y o Medicine and Pha macy o Tangie , Abdelmalek Essaâdi Uni e si y, Tangie , Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1550-1556
Publica ion his o y: Recei ed on 01 June 2025; e ised on 13 July 2025; accep ed on 15 July 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.1.2598
Abs ac
In oduc ion: Ch onic obs uc i e pulmona y disease (COPD) is cha ac e ized by i e e sible ai low limi a ion,
leading o p og essi e espi a o y dys unc ion, exe cise in ole ance, and lean body mass loss. The BODE index,
in eg a ing body mass index, obs uc ion, dyspnea, and exe cise capaci y, p o ides supe io p ognos ic accu acy
compa ed o indi idual pa ame e s alone. This s udy aimed o e alua e he p ognosis o COPD pa ien s using he BODE
index as a mul idimensional p edic i e ool.
Ma e ials and me hods: A p ospec i e longi udinal desc ip i e and analy ical s udy was conduc ed on 103 COPD
pa ien s in he s able phase. The BODE index combines ou pa ame e s: body mass index (B), ai way obs uc ion
measu ed by FEV₁ (O), dyspnea acco ding o he mMRC scale (D), and exe cise capaci y assessed by he 6-minu e walk
es (E). Co ela ions be ween he BODE index and clinical pa ame e s we e analyzed by qua iles.
Resul s: The s udy popula ion was p edominan ly male (96.1%) wi h a mean age o 63.6 ± 9.5 yea s. The mean BODE
index was 3.7 ± 2. Dis ibu ion by qua iles showed: qua ile 1 (sco e 0-2): 30%, qua ile 2 (sco e 3-4): 33%, qua ile 3
(sco e 5-6): 28.1%, and qua ile 4 (sco e 7-10): 8.7%. S a is ically signi ican co ela ions (p<0.001) we e obse ed
be ween he BODE index and GOLD se e i y, 6-minu e walk es dis ance, and body mass index. P og essi e and
signi ican de e io a ion o clinical and unc ional pa ame e s was demons a ed be ween he i s and las qua iles:
dec ease in BMI (22 o 18.9 kg/m²), FEV₁ (50.6% o 38%), and walking dis ance (392.7m o 260m), wi h inc eased
dyspnea (2.69 o 3.7).
Conclusion: The BODE index p o es o be a pa icula ly ele an mul idimensional assessmen ool o moni o ing
COPD pa ien s. S a is ically signi ican co ela ions wi h essen ial clinical pa ame e s con i m i s alue as a eliable
p ognos ic ool, p o iding a comp ehensi e and accu a e assessmen o COPD se e i y.
Keywo ds: COPD; BODE Index; P ognosis; Mul idimensional Assessmen ; Exe cise Capaci y; Dyspnea
1. In oduc ion
Ch onic obs uc i e pulmona y disease (COPD) is cha ac e ized by ai low limi a ion ha is no o incomple ely
e e sible. This p og essi e ch onic disease e ol es owa ds impai ed espi a o y unc ion, wo sening exe cise
in ole ance, and loss o lean body mass in COPD pa ien s. All hese pa ame e s con ibu e o he e olu ion o he BODE
sco e, which uses he ollowing e alua ion c i e ia: Body Mass Index (BMI), FEV₁, dyspnea, and he 6-minu e walk es
(6MWT), e lec ing many o he impai men s and disabili ies a ec ing hese pa ien s. Each i em co esponds o a ce ain
numbe o poin s, and he o al o all poin s de e mines he BODE index sco e, which anges om 0 o 10. [1]
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Wo ldwide, he e a e app oxima ely h ee million dea hs om COPD e e y yea . By 2060, COPD is expec ed o cause
mo e han 5.4 million dea hs annually, due o inc eased smoking in low and middle-income coun ies and aging
popula ions in high-income coun ies. [2]
The BODE index, combining body mass index, espi a o y obs uc ion, dyspnea, and exe cise capaci y, o e s a mo e
p ecise o e all sco e o p edic ing pa ien su i al han each o i s pa ame e s sepa a ely.
2. Ma e ials e me hods
2.1. S udy Type
A p ospec i e longi udinal desc ip i e and analy ical s udy was conduc ed o e a 2-yea pe iod om 2023 o 2025.
2.1.1. S udy Popula ion
• Pa ien s wi h COPD e alua ed du ing s able consul a ions o hei disease.
• Inclusion c i e ia: Con i med diagnosis o COPD and pa ien in s able phase o he disease.
• Exclusion c i e ia: Recen exace ba ion and se e e como bidi ies incompa ible wi h he s udy.
2.2. Main Objec i e
To e alua e he p ognosis o COPD pa ien s using he BODE index as a p edic i e ool.
2.2.1. S a is ical Analysis
• Calcula ion o means and s anda d de ia ions.
• Co ela ion analysis be ween di e en pa ame e s.
• Analysis o dis ibu ion acco ding o BODE index qua iles using Jamo i so wa e.
3. Resul s
We collec ed da a on 103 COPD pa ien s, wi h a clea male p edominance: 96.1% men (99) and 3.8% women (4), wi h
a mean age o 63.6 ± 9.5 yea s. The a e age obacco consump ion was 30 pack-yea s. Cannabis use was ound in 37
pa ien s (35.9%) and alcoholism in 27 pa ien s (26.2%).
In ou s udy, se e al como bidi ies we e iden i ied among he pa ien s. Malnu i ion was he mos common, a ec ing
35.9% o he popula ion. This was ollowed by hea diseases (25.2%), diabe es (17.4%), anemia (11.6%), lung cance
(4.8%), and pulmona y embolism (3.8%).
Dyspnea, he ca dinal symp om o COPD, was mainly p esen in ou coho . Acco ding o he mMRC classi ica ion, i s
se e i y a ied: 7.7% o pa ien s p esen ed wi h s age I, 35.9% wi h s age II, 27.1% wi h s age III, and 29.1% wi h s age
IV, illus a ing he di e si y and p og ession o dyspnea in hese pa ien s.
The spi ome y analysis o he pa icipan s e ealed h ee main p o iles: a non- e e sible obs uc i e en ila o y
diso de in 47.5% o pa ien s (49 cases), a mixed en ila o y diso de in 39.8% (41 cases), and a es ic i e p o ile in
12.6% (13 cases).
Acco ding o he GOLD (Global Ini ia i e o Ch onic Obs uc i e Lung Disease) classi ica ion, which assesses COPD
se e i y h ough spi ome ic s ages (1-4) based on ai low limi a ion and clinical g oups (A, B, E) based on symp om
bu den and exace ba ion isk, he dis ibu ion o COPD pa ien s was cha ac e ized by a p edominance o g oup B (63%),
ollowed by g oup E (33%), and a mino i y o pa ien s in g oup A (4%), e lec ing he di e si y o he disease's clinical
p o iles. Mos pa ien s included had mode a e- o-se e e COPD, wi h s age I in 6%, s age II in 48%, s age III in 34% and
s age IV in 12%. [Figu e 1]
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Le cha - GOLD s ages: S age 1 (6%), S age 2 (48%), S age 3 (34%), S age 4 (12%); Righ cha - GOLD g oups: G oup A (4%), G oup B (63%),
G oup E (33%).
Figu e 1 Dis ibu ion o COPD pa ien s acco ding o GOLD classi ica ion
Body mass index (BMI) in COPD pa ien s a e aged 21.8 ± 3.9 kg/m2 (14-31 kg/m2). Du ing he 6-minu e walk es
(6MWT), he mean dis ance co e ed was 391 me e s, wi h signi ican a iabili y anging om 150 o 620 me e s.
Pa ien s' exe cise capaci y showed a signi ican dis ibu ion: 32% had minimal limi a ions, 66% mode a e, and only
1.9% se e e.
The mean BODE index in ou popula ion was 3.7 ± 2 wi h qua ile 1 (sco e 0-2) in 30% o COPD pa ien s and qua ile 2
(sco e 3-4) in 33%, qua ile 3 (sco e 5-6) in 28.1% and qua ile 4 (sco e 7-10) in 8.7%, sugges ing ha ex eme cases
emained ela i ely a e in ou popula ion. [Figu e 2]
• Qua ile 1 (sco e 0–2): 30% o pa ien s sco e in his ca ego y, indica ing mild disease se e i y.
• Qua ile 2 (sco e 3–4): 33% o pa ien s wi h mode a e disease se e i y.
• Qua ile 3 (sco e 5–6): 28.1% o pa ien s sco e in his ange, indica ing highe se e i y.
• Qua ile 4 (sco e 7–10): Only 8.7% o pa ien s ha e sco es in his ca ego y, sugges ing ha ew pa ien s p esen
wi h se e e cases.
Figu e 2 Dis ibu ion o COPD pa ien s by BODE index qua iles
In ou s udy, s a is ical analysis e ealed signi ican co ela ions o he BODE index wi h h ee essen ial clinical
pa ame e s
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3.1. Co ela ion wi h GOLD se e i y
The p- alue <0.001 indica es a s a is ically signi ican ela ionship be ween he BODE Index and GOLD classi ica ion.
This sugges s ha he BODE Index is an excellen indica o o he p og ession and se e i y o Ch onic Obs uc i e
Pulmona y Disease (COPD). The highe he BODE sco e, he mo e ad anced he GOLD s age, con i ming he eliabili y
o his index as a p ognos ic ool.
3.2. Co ela ion wi h he 6-Minu e Walk Tes (6 MWT)
The p- alue <0.001 demons a es a s a is ically signi ican link be ween he BODE index and he dis ance co e ed
du ing he walking es . In ou s udy, his co ela ion allows o a p ecise e alua ion o he pa ien s' unc ional capaci y
and e o limi a ion. A highe BODE sco e co esponds o a sho e walking dis ance, e lec ing he de e io a ion o
physical capaci y.
3.3. Co ela ion wi h Body Mass Index (BMI)
The p- alue <0.001 e eals a signi ican ela ionship be ween he BODE index and pa ien s' nu i ional s a us. Ou
esul s highligh he impac o body composi ion on COPD p og ession. A highe BODE sco e is associa ed wi h a lowe
BMI, indica ing an inc eased isk o malnu i ion in pa ien s wi h mo e se e e COPD.
These esul s con i m ha he BODE index is a powe ul p ognos ic ool. I p o ides a mul idimensional assessmen o
COPD, in eg a ing clinical, unc ional and nu i ional aspec s wi h s a is ically signi ican accu acy.
Table 1 Clinical and unc ional cha ac e is ics o COPD pa ien s acco ding o he qua iles o he BODE Index
Cha ac e is ic
To al
Qua ile 1 [0-2]
Qua ile 2 [3-4]
Qua ile 3 [5-6]
Qua ile 4 [7-10]
P alue
No Pa ien s
103
31
34
29
9
Sex a io M/F
99/4
29/2
34/0
28/1
8/1
NS
Age
63,6
64,1±9
63±9,6
63,6±9,5
64,2±8,1
NS
BMI
21,8
22±3,8
22±3,8
20,7±3,9
18,9±4,1
0,001
Dyspnea
2,72
2,69±1
2,7±0,96
3,3±0,97
3,7±0,95
0,001
FEV₁
53,9
50,6±16,7
51,8±16,6
37,3±16,5
38±18,1
0,001
6MWT
391
392,7±94,8
396,4±93,7
347,4±95,5
260±91,3
0,001
BODE Index
3,7
1,54±1,9
3,64±1,9
5,44±1,9
7,33±2,1
CAT
12
10,2 ± 6,4
12,3±6,4
15,6±6,4
18,5±6,9
NS
GOLD
I
6
3
1
0
0
II
50
26
14
6
2
III
35
2
13
15
4
IV
12
0
6
8
3
Abb e ia ions: BMI: Body Mass Index, FEV₁: Fo ced Expi a o y Volume in 1 second, 6MWT: 6-Minu e Walk Tes , GOLD: Global Ini ia i e o Ch onic
Obs uc i e Lung Disease, CAT: COPD Assessmen Tes , NS: Non-Signi ica i e
3.3.1. BODE Index
The s a is ical analysis e eals a signi ican deg ada ion (p=0.001) o clinical and unc ional pa ame e s depending on
he se e i y o he disease. The e was a p og essi e and signi ican dec ease in BMI ( om 22 o 18.9 kg/m²), FEV₁ ( om
50.6% o 38%) and dis ance co e ed in he 6-minu e walk es ( om 392.7m o 260m), associa ed wi h a signi ican
inc ease in dyspnea ( om 2.69 o 3.7) be ween he i s and las qua iles. The CAT sco e, which is he COPD Assessmen
Tes - a sho , simple and ep oducible ques ionnai e designed o p o ide a apid bu eliable assessmen o COPD's
impac on he pa ien 's daily li e by e alua ing symp oms such as cough, phlegm, ches igh ness, b ea hlessness, ac i i y
limi a ions, con idence, sleep quali y, and ene gy le els - shows an inc easing end ( om 10.2 o 18.5) al hough no
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s a is ically signi ican , possibly due o he small sample size in he las qua ile (n=9). These esul s demons a e a
s ong co ela ion be ween disease p og ession and de e io a ion o physiological pa ame e s, pa icula ly ma ked in
he las qua ile.
I is impo an o acknowledge ha he signi ican co ela ions obse ed be ween he BODE index and i s indi idual
elemen s (BMI, 6MWT, and dyspnea se e i y) a e expec ed, since hese pa ame e s a e pa o he index i sel . These
co ela ions do no ep esen new indings bu a he se e as a alida ion o he index's in e nal consis ency wi hin
ou speci ic coho . The p ima y alue o ou analysis lies in demons a ing ha he BODE index main ains i s expec ed
co ela ions in ou Mo occan COPD popula ion, con i ming i s applicabili y ac oss di e en demog aphic con ex s, and
p o iding aluable insigh s in o he dis ibu ion pa e ns o BODE qua iles in ou egional popula ion.
4. Discussion
In 2004, Celli e al. in oduced he BODE index, a p ognos ic sco e o es ima ing 52-mon h mo ali y in COPD pa ien s.
This inno a i e index in eg a es ou key dimensions o he disease: B o Body mass index (BMI), O o Obs uc ion
(FEV₁ in % o p edic ed), D o Dyspnea (MRC scale), and E o Exe cise capaci y (dis ance co e ed in 6-minu e walk
es ), hus o e ing a mul idimensional and mo e accu a e assessmen o pa ien heal h s a us. [1]
In ou se ies, he obse ed popula ion was p edominan ly elde ly (a e age age o 63.6 yea s). This igu e emains
compa able o o he s udies. [4-6]
The dis ibu ion o pa ien s acco ding o he GOLD classi ica ion is e y simila o he da a epo ed by N. Fe al e al.,
wi h a ela i ely compa able dis ibu ion be ween s ages: s age I (5% s. 5.8%), s age II (64.4% s. 48.5%), s age III
(26.7% s. 33.9%) and s age IV (3.7% s. 11.6%). [4]
Ou a e age BODE index was 3.7 ± 2, a esul compa able o hose o he s udies by Loïc Pé an e al. (4.16) and Anne
Houssiè e e al. (4.0), bu signi ican ly di e en om ha o he s udy by N. Fe al e al. (1.75 ± 2) as shown in able 2
below. The a iabili y obse ed in he BODE index could be explained by signi ican di e ences in he cha ac e is ics o
he s udied popula ion, pa icula ly in e ms o disease se e i y, demog aphic p o ile, and me hodological c i e ia
speci ic o each s udy. [4-6]
Rega ding he dis ibu ion o he popula ion acco ding o he BODE index, ou esul s showed no able simila i ies wi h
he s udy by Anne Houssiè e e al., wi h a nea ly compa able dis ibu ion among he di e en qua iles: we obse ed
30% s 37% o pa ien s wi h a sco e be ween 0 and 2, 33% s 25% be ween 3 and 4, 28.1% s 22% be ween 5 and 6,
and 8.7% s 16% be ween 7 and 10. [6]
Table 2 Compa ison o clinical and unc ional cha ac e is ics o COPD pa ien s wi h o he e e ence s udies
N. Fe al e al
Loïc Pé an e al
Anne Houssiè e e al
Ou s udy
Age
61
63,2
64
63,6
BMI
22,5
27,1
25,5
21,8
Dyspnea
-
2,19
2,5
2,72
6MWT
366
346
410
391
FEV₁
-
42,1%
51%
53,9%
GOLD
-
2/15/26/23
-
6/50/35/12
BODE
1,75
4,16
4
3,7
Mo ali y isk is s a i ied in o ou qua iles, acco ding o an ascending p og ession o isk. Qua ile 4 ep esen s he
highes le el o isk and he e o e iden i ies pa ien s wi h he mos se e e o ms o he disease. [7] In he s udy,
Medinas-Amo ós [8] demons a ed ha he BODE index is a ele an ool o assessing pa ien s' quali y o li e. He wo k
showed an in e se co ela ion be ween he BODE index and quali y o li e: he highe he index, he wo se he quali y
o li e. Two s udies [3, 9] ha e es ablished ha he BODE index is a eliable indica o o p edic ing he isk o
hospi aliza ion in pa ien s. The wo k o Cô e and Celli [10] highligh ed a dual bene i o espi a o y ehabili a ion: an
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imp o emen in he BODE index and a educ ion in he isk o mo ali y. These esul s sugges ha he BODE index can
be used as a ele an assessmen ool in he ollow-up o espi a o y ehabili a ion p og ams.
The BODE index has been shown o be a be e p edic o o isk o dea h in COPD pa ien s han he GOLD classi ica ion,
which is based on FEV₁ [1-3]. Howe e , in ou coho , he e alua ion o he mo ali y a e has no ye been pe o med
as his is an ongoing p ospec i e s udy.
5. Conclusion
The BODE index p o es o be a pa icula ly ele an mul idimensional assessmen ool o moni o ing COPD pa ien s.
Ou s udy demons a ed s a is ically signi ican co ela ions (p<0.001) be ween he BODE index and essen ial clinical
pa ame e s: GOLD se e i y, exe cise capaci y (6MWT) and nu i ional s a us (BMI).
The dis ibu ion o ou popula ion acco ding o BODE index qua iles (mean 3.7 ± 2) is compa able o he li e a u e,
wi h mos pa ien s in he in e media e qua iles. Ou de ailed analysis e ealed a p og essi e and signi ican
de e io a ion in clinical and unc ional pa ame e s based on disease se e i y, pa icula ly ma ked in he las qua ile.
These esul s con i m he alue o he BODE index as a eliable p ognos ic ool, p o iding a comp ehensi e and accu a e
assessmen o COPD se e i y. I s use in ou ine clinical p ac ice could imp o e pa ien moni o ing and adap a ion o
he apeu ic s a egies, pa icula ly in he con ex o espi a o y ehabili a ion p og ams. Addi ional longe - e m s udies
a e needed o e alua e i s impac on mo ali y p edic ion in ou coho .
S udy limi a ions
Se e al limi a ions should be acknowledged in ou s udy. The ela i ely modes sample size (n=103), pa icula ly wi h
only 9 pa ien s in qua ile 4, es ic s s a is ical powe o subg oup analyses. The exclusi e inclusion o pa ien s in
s able phase may in oduce selec ion bias, po en ially unde ep esen ing se e e cases. As ou p ospec i e s udy is
ongoing, mo ali y p edic ion, he p ima y pu pose o he BODE index has no ye been e alua ed, and he absence o
long- e m ollow-up p e en s assessmen o disease p og ession o e ime. Finally, he exclusion o pa ien s wi h ecen
exace ba ions and se e e como bidi ies may limi he applicabili y o he b oade mul imo bid COPD popula ion.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic -o -in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
Re e ences
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