The BODE index in contemporary clinical practice: diagnostic and prognostic value

Authors

DOI:

https://doi.org/10.14739/2310-1210.2026.4.350252

Keywords:

BODE index, COPD, prognostic index, mortality, exacerbations, pulmonary rehabilitation, lung volume reduction surgery, lung transplantation, multidimensional assessment

Abstract

Aim. To systematically summarize and appraise recent scientific data (2020–2025) on the diagnostic and prognostic value of the BODE index in clinical practice, as well as to determine its place among other multidimensional models for assessing the course of chronic obstructive pulmonary disease (COPD).

Materials and methods. A narrative review of modern published literature in international scientometric databases (PubMed, Scopus, Web of Science) was conducted, including systematic reviews, clinical trials, validation studies, and international recommendations published in 2020–2025. The review included more than 30 sources examining the application of the BODE index, its modifications, and alternative multidimensional models in various clinical scenarios.

Results. The analysis of the current literature confirmed that the BODE index retains strong independent predictive accuracy for mortality, risk of exacerbations and hospitalizations in patients with COPD. The exercise capacity component ensures its sensitivity to systemic manifestations of the disease and enables a more comprehensive evaluation of the functional status of patients compared to unidimensional indicators. Comparison with other multidimensional indices (ADO, DOSE, BODEx, etc.) showed that the choice of the tool should depend on the clinical goal, availability of components and population characteristics. Modern modifications of the BODE and alternative physical performance tests extend its applicability in resource-limited settings.

Conclusions. The BODE index remains a relevant and clinically significant tool for multidimensional assessment of COPD in current practice. Its use is appropriate for risk stratification, monitoring the course of the disease, assessing the effectiveness of non-pharmacological interventions, and supporting clinical decision-making. Further research should focus on integrating the BODE index with new prognostic approaches to advance personalized management strategies in COPD.

Author Biographies

R. A. Pozhydaiev, Zaporizhzhia State Medical and Pharmaceutical University

MD, PhD student, Department of Propaedeutics of Internal Medicine, Radiology, and Radiation Therapy, Educational and Scientific Institute of Postgraduate Education

L. V. Lukashenko, Zaporizhzhia State Medical and Pharmaceutical University

MD, PhD, DSc, Professor, Head of the Department of Propaedeutics of Internal Medicine, Radiology, and Radiation Therapy, Educational and Scientific Institute of Postgraduate Education

References

  1. Gómez-Martínez M, Rodríguez-García W, González-Islas D, Orea-Tejeda A, Keirns-Davis C, Salgado-Fernández F, et al. Impact of Body Composition and Sarcopenia on Mortality in Chronic Obstructive Pulmonary Disease Patients. J Clin Med. 2023;12(4):1321. doi: https://doi.org/10.3390/jcm12041321
    | |
  2. Corlateanu A, Plahotniuc A, Corlateanu O, Botnaru V, Bikov A, Mathioudakis AG, Covantev S, Siafakas N. Multidimensional indices in the assessment of chronic obstructive pulmonary disease. Respir Med. 2021;185:106519. doi: https://doi.org/10.1016/j.rmed.2021.106519
    | |
  3. Aung H, Vermeersch K, McAuley H, Ramakrishnan S, Abdo M, Beersaerts A, et al. Multidimensional prognostic risk stratification of COPD exacerbations: the baseline, acuity, and trigger (BAt) model. Lancet Respir Med. 2026;14(2):174-86. doi: https://doi.org/10.1016/S2213-2600(25)00362-5
    | |
  4. Leard LE, Holm AM, Valapour M, Glanville AR, Attawar S, Aversa M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2021;40(11):1349-79. doi: https://doi.org/10.1016/j.healun.2021.07.005
    | |
  5. Mumtaz M, Venkatachalapathi S, Mohammed T, Sudeshna P, Kota T, Gandhi SS, et al. The BODE (Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity) Index in Chronic Obstructive Pulmonary Disease: A Comprehensive Clinical Assessment Tool. Cureus. 2025;17(10):e95206. doi: https://doi.org/10.7759/cureus.95206
    |
  6. Bellou V, Belbasis L, Konstantinidis AK, Tzoulaki I, Evangelou E. Prognostic models for outcome prediction in patients with chronic obstructive pulmonary disease: systematic review and critical appraisal. BMJ. 2019;367:l5358. doi: https://doi.org/10.1136/bmj.l5358
    | |
  7. Almagro P, Soler-Cataluña JJ, Huerta A, González-Segura D, Cosío BG; CLAVE Study Investigators. Impact of comorbidities in COPD clinical control criteria. The CLAVE study. BMC Pulm Med. 2024;24(1):6. doi: https://doi.org/10.1186/s12890-023-02758-0
    | |
  8. Testa D, Magnoni P, Fanizza C, Bussa M, Zanfino A, Khaleghi Hashemian D, et al. Prognostic Models for Disease Progression and Outcomes in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. J Clin Med. 2025;14(24):8725. doi: https://doi.org/10.3390/jcm14248725
    | |
  9. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195(5):557-82. doi: https://doi.org/10.1164/rccm.201701-0218PP
    | |
  10. Medina-Mirapeix F, Valera-Novella E, Morera-Balaguer J, Bernabeu-Mora R. Prognostic value of the five-repetition sit-to-stand test for mortality in people with chronic obstructive pulmonary disease. Ann Phys Rehabil Med. 2022;65(5):101598. doi: https://doi.org/10.1016/j.rehab.2021.101598
    | |
  11. Vieira EB, Degani-Costa LH, Amorim BC, Oliveira LB, Miranda-Silva T, Sperandio PC, et al. Modified BODE Index to Predict Mortality in Individuals With COPD: The Role of 4-Min Step Test. Respir Care. 2020;65(7):977-83. doi: https://doi.org/10.4187/respcare.06991
    | |
  12. Golpe R, Esteban C, Figueira-Gon Alves JM, Amado-Diago CA, Blanco-Cid N, Aramburu A, et al. Development and validation of a prognostic index (BODEXS90) for mortality in stable chronic obstructive pulmonary disease. Pulmonology. 2023;29(4):276-83. doi: https://doi.org/10.1016/j.pulmoe.2020.10.008
    | |
  13. Kamath S, Kumar A, Panda SK, Samanta RP. Correlation of BODE index with quality of life in stable Chronic Obstructive Pulmonary Disease (COPD) patients - A prospective study. J Family Med Prim Care. 2020;9(11):5606-13. doi: https://doi.org/10.4103/jfmpc.jfmpc_735_20
    |
  14. Shah K, Bhat HP, Kadam M, Kachalia P, Kuchi Y, Siroha M, et al. Assessment of the BODE Index and Its Association With Inflammatory Mediators in Chronic Obstructive Pulmonary Disease (COPD) Patients. Cureus. 2024;16(10):e72172. doi: https://doi.org/10.7759/cureus.72172
    |
  15. Robles-Hernández R, Centeno-Saenz GI, Ramírez-Venegas A, Thirion-Romero I, Hernández-Zenteno R, Guinto-Ramírez SP, et al. Validation of new predictors of mortality and BODE index variants in patients with COPD at moderate altitude. ERJ Open Res. 2025;11(1):00333-2024. doi: https://doi.org/10.1183/23120541.00333-2024
    | |
  16. Bernabeu-Mora R, Valera-Novella E, Sánchez-Martínez MP, Medina-Mirapeix F. Improving the Reliability Between the BODE Index and the BODS Index in Which the 6-Min Walk Test Was Replaced with the Five-Repetition Sit-to-Stand Test. Int J Chron Obstruct Pulmon Dis. 2022;17:643-52. doi: https://doi.org/10.2147/COPD.S347696
    | |
  17. Saman M, Naseem S, Baneen U. Inflammatory Markers and Disease Severity in COPD: Insights from the BODE Index. African Journal of Biomedical Research. 2024;27(4S):11036-43. doi: https://doi.org/10.53555/AJBR.v27i4S.5799
  18. Chai CS, Ng DL, Bt Mos S, Ibrahim M, Tan SB, Pang YK, et al. COPD exacerbations and patient-reported outcomes according to post-bronchodilator FEV1 - a post-hoc analysis of pooled data. BMC Pulm Med. 2023;23(1):150. doi: https://doi.org/10.1186/s12890-023-02436-1
    | |
  19. Brat K, Svoboda M, Zatloukal J, Plutinsky M, Volakova E, Popelkova P, Novotna B, Dvorak T, Koblizek V. Prognostic Properties of the GOLD 2023 Classification System. Int J Chron Obstruct Pulmon Dis. 2023;18:661-7. doi: https://doi.org/10.2147/COPD.S410372
    | |
  20. Bernabeu-Mora R, García-Guillamón G, Valera-Novella E, Giménez-Giménez LM, Escolar-Reina P, Medina-Mirapeix F. Frailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal study. Ther Adv Respir Dis. 2017;11(10):383-92. doi: https://doi.org/10.1177/1753465817726314
    | |
  21. Ouattas A, Azarian M, Bryant MS, Nguyen CK, Rodriguez N, Torres Ruiz IP, et al. Telehealth pulmonary rehabilitation enhances functional capacity and quality of life in veterans with chronic obstructive pulmonary disease: a 12-week single-arm intervention study. Sci Rep. 2025;15(1):43118. doi: https://doi.org/10.1038/s41598-024-84518-6
    | |
  22. Park JH, Lee HJ, Rhee CK, Park YB, Lee JH, Yoon HK, et al. Validation of the modified BODE index using the activity domain of St George's Respiratory Questionnaire. ERJ Open Res. 2025;11(5):01239-2024. doi: https://doi.org/10.1183/23120541.01239-2024
    | |
  23. Celli BR, Wedzicha JA. Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease. N Engl J Med. 2019;381(13):1257-66. doi: https://doi.org/10.1056/NEJMra1900500
    | |
  24. Cheng W, Zhou A, Song Q, Zeng Y, Lin L, Liu C, et al. Development and validation of a nomogram model for mortality prediction in stable chronic obstructive pulmonary disease patients: A prospective observational study in the RealDTC cohort. J Glob Health. 2024;14:04049. doi: https://doi.org/10.7189/jogh.14.04049
    | |
  25. Li CL, Lin MH, Chen PS, Tsai YC, Shen LS, Kuo HC, et al. Using the BODE Index and Comorbidities to Predict Health Utilization Resources in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2020;15:389-95. doi: https://doi.org/10.2147/COPD.S234363
    | |
  26. Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, et al. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med. 2023;207(7):819-37. doi: https://doi.org/10.1164/rccm.202301-0106PP
    | |
  27. Li CL, Chang HC, Tseng CW, Tsai YC, Liu JF, Chan CC, et al. The DOSE index in chronic obstructive pulmonary disease: evaluating healthcare costs. BMC Pulm Med. 2024;24(1):560. doi: https://doi.org/10.1186/s12890-024-03368-0
    | |
  28. Ajay D, Bhatnagar M, Chandra N. BODE index: A predictor of hospitalization and severity in chronic obstructive pulmonary disease patients. Bioinformation. 2025;21(7):1831-35. doi: https://doi.org/10.6026/973206300211831
    |
  29. Li CL, Chang HC, Tseng CW, Tsai YC, Liu JF, Tsai ML, et al. Comparison of BODE and ADO Indices in Predicting COPD-Related Medical Costs. Medicina (Kaunas). 2023;59(3):577. doi: https://doi.org/10.3390/medicina59030577
    | |
  30. Youk CS, Kim DK, Rhee CK, Choi CW, Lim SY, Kim SH, et al. Early termination of six-min walk test in COPD as simple prognostic marker vs. BODE index. Respir Med. 2025;250:108538. doi: https://doi.org/10.1016/j.rmed.2025.108538
    | |
  31. Reed RM, Cabral HJ, Dransfield MT, Scharf SM, Sin DD, Celli BR, et al. Survival of lung transplant candidates with COPD: BODE score reconsidered. Chest. 2018;153(3):697-701. doi: https://doi.org/10.1016/j.chest.2017.10.008
    | |
  32. Mendes Xavier D, Lanza Galvão E, Aliane Fonseca A, de Souza GM, Pereira Lima V. Effects of Home-Based Pulmonary Rehabilitation on Dyspnea, Exercise Capacity, Quality of Life and Impact of the Disease in COPD Patients: A Systematic Review. COPD. 2022;19(1):18-46. doi: https://doi.org/10.1080/15412555.2021.2020234
    | |

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Published

2026-07-08

How to Cite

1.
Pozhydaiev RA, Lukashenko LV. The BODE index in contemporary clinical practice: diagnostic and prognostic value. Zaporozhye Medical Journal [Internet]. 2026Jul.8 [cited 2026Jul.13];28(4):371-9. Available from: https://zmj.zsmu.edu.ua/article/view/350252

Issue

Vol. 28 No. 4 (2026)

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Review

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Copyright (c) 2026 R. A. Pozhydaiev, L. V. Lukashenko

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