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The SAFE (SGRQ score, air-flow limitation and exercise tolerance) Index: a new composite score for the stratification of severity in chronic obstructive pulmonary disease

¹ Department of Medicine, International Islamic University Malaysia
² Department of Medicine, Universiti Kebangsaan Malaysia
³ Department of Medicine, Universiti Kebangsaan Malaysia
⁴ Universiti Kebangsaan Malaysia
⁵ Department of Medicine, Universiti Kebangsaan Malaysia
⁶ Department of Medicine, Universiti Kebangsaan Malaysia

Correspondence to:
Correspondence to:
Assistant Professor Dr Mohd Shah Azarisman
Department of Medicine, International Islamic University Malaysia, Jalan Hospital Campus, 25150 Kuantan, Pahang, Malaysia; risman1973{at}hotmail.com

Background: This study was proposed to develop a composite of outcome measures using forced expiratory volume percentage of predicted, exercise capacity and quality of life scores for assessment of chronic obstructive pulmonary disease (COPD) severity.

Materials and methods: Eighty-six patients with COPD were enrolled into a prospective, observational study at the respiratory outpatient clinic, National University Hospital Malaysia (Hospital Universiti Kebangsaan Malaysia - HUKM), Kuala Lumpur.

Results: Our study found modest correlation between the forced expiratory volume in 1 s (FEV₁), 6 min walk distance and the SGRQ scores with mean (SD) values of 0.97 (0.56) litres/s, 322 (87) m and 43.7 (23.6)%, respectively. K-Means cluster analysis identified four distinct clusters which reached statistical significance which was refined to develop a new cumulative staging system. The SAFE Index score correlated with the number of exacerbations in 2 years (r = 0.497, p<0.001).

Conclusion: We have developed the SGRQ, Air-Flow limitation and Exercise tolerance Index (SAFE Index) for the stratification of severity in COPD. This index incorporates the SGRQ score, the FEV₁ % predicted and the 6 min walk distance. The SAFE Index is moderately correlated with the number of disease exacerbations.

Abbreviations: ANOVA, analysis of variance; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 s; FEV₁%Pred, percentage of predicted FEV₁; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; HRQOL, Health-Related Quality of Life Questionnaire; QOL, quality of life; SGRQ, St George’s Respiratory Questionnaire