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. 2010 Mar;20(3):223-32.
doi: 10.1016/j.annepidem.2009.11.005.

Predictors of mortality in elderly subjects with obstructive airway disease: the PILE score

Nitin Mehrotra  1 , Amado X Freire, Douglas C Bauer, Tamara B Harris, Anne B Newman, Stephen B Kritchevsky, Bernd Meibohm; Health ABC Study
Affiliations

Predictors of mortality in elderly subjects with obstructive airway disease: the PILE score

Nitin Mehrotra et al. Ann Epidemiol. 2010 Mar.

Abstract

Purpose: To identify significant covariates in addition to spirometry that predict mortality in elderly subjects with obstructive airway disease (OAD).

Methods: Two hundred sixty-eight (268) participants with OAD from the Health, Aging and Body Composition study, a community-based observational cohort of well-functioning elderly aged 70-79 years, were followed on average for 6.1 years. Covariates related to pulmonary and physical function, comorbidity, demographics, and three inflammatory markers (interleukin-6, tumor necrosis factor-alpha, C-reactive protein) were evaluated for their association with all-cause mortality (31%) by means of Kaplan Meier analysis and Cox proportional hazards modeling.

Results: Percent predicted forced expiratory volume in one second (PPFEV1; hazard ratio [HR] = 2.03, p < 0.0001), knee extensor strength (HR = 1.36, p = 0.0002), interleukin-6 (HR = 1.37, p = 0.0002) and 400 m corridor walk time (HR = 1.24, p = 0.008) significantly predicted mortality. A multidimensional index, the PILE score, was constructed from PPFEV(1), interleukin-6, and knee extensor strength. Each one-point increase in PILE score (range: 1-10) was associated with a 30% increase in mortality (95% confidence interval: 0.16-0.47) after adjusting for age, race, gender, smoking, and comorbidity, resulting in a 10.4-fold higher risk of death between the highest and lowest risk category.

Conclusions: Subjects with OAD have a wide gradient of risk for mortality that can potentially be incorporated in clinical decision making.

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Figures

FIGURE 1
FIGURE 1
268 participants with obstructive airways disease (OAD) were selected from the Health ABC cohort based on ATS criteria.
FIGURE 2
FIGURE 2
Kaplan Meier plot using quartiles of PILE score as stratum (P < 0.0001). Higher PILE scores indicate greater risk of death. The table indicates the number of individuals in each PILE score quartile.
FIGURE 3
FIGURE 3
Kaplan Meier plot using quartiles of the modified BODE index as stratum (P = 0.003). The table indicates the number of individuals in each BODE index quartile.
FIGURE 4
FIGURE 4
Kaplan Meier plot using PPFEV1 as stratum (>80%, 51–80%, <50%) (P = 0.0002). The table indicates the number of individuals in each PPFEV1 category.
See this image and copyright information in PMC

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