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Original Research: COPD |

Short- and Medium-term Prognosis in Patients Hospitalized for COPD ExacerbationPrognosis in Patients Hospitalized for COPD: The CODEX Index

Pedro Almagro, MD; Joan B. Soriano, MD; Francisco J. Cabrera, MD; Ramon Boixeda, MD; M. Belen Alonso-Ortiz, MD; Bienvenido Barreiro, MD; Jesus Diez-Manglano, MD; Cristina Murio, MD; Josep L. Heredia, MD; the Working Group on COPD, Spanish Society of Internal Medicine*
Author and Funding Information

From the Internal Medicine Service (Dr Almagro), and the Respiratory Service (Drs Barreiro and Heredia), Hospital Universitario Mutua De Terrassa, Universidad de Barcelona, Barcelona; Programa de Epidemiología e Investigación Clínica (Dr Soriano), Fundación Caubet-Cimera, Centro Internacional de Medicina Respiratoria Avanzada, Baleares; the Internal Medicine Service (Dr Cabrera), Hospital General Universitario Gregorio Marañón, Madrid; the Internal Medicine Service (Dr Boixeda), Hospital de Mataró, Barcelona; the Medical Department (Dr Murio), Laboratorios Chiesi, Barcelona; the Internal Medicine Service (Dr Alonso-Ortiz), Hospital Juan Negrín, Gran Canaria; and the Internal Medicine Service (Dr Diez-Manglano), Hospital Royo Villanova, Zaragoza, Spain.

Correspondence to: Pedro Almagro, MD, Internal Medicine Service, Hospital Universitario Mutua De Terrassa, Universidad de Barcelona, Plaza Dr Robert No. 5, 08221, Terrassa, Barcelona, Spain; e-mail: 19908pam@comb.cat


For editorial comment see page 934

Dr Soriano is currently at FISIB-IdISPA Hospital Universitari Son Espases (Palma de Mallorca, Spain).

*A complete list of study investigators is provided in e-Appendix 1.

Funding/Support: This work was supported by Chiesi España.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):972-980. doi:10.1378/chest.13-1328
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Background:  No valid tools exist for evaluating the prognosis in the short and medium term after hospital discharge of patients with COPD. Our hypothesis was that a new index based on the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index can accurately predict mortality, hospital readmission, and their combination for the period from 3 months to 1 year after discharge in patients hospitalized for COPD.

Methods:  A multicenter study of patients hospitalized for COPD exacerbations was used to develop the CODEX index, and a different patient cohort was used for validation. Comorbidity was measured using the age-adjusted Charlson index, whereas dyspnea, obstruction, and severe exacerbations were calculated according to BODEX (BMI, airflow obstruction, dyspnea, and previous severe exacerbations) thresholds. Information about mortality and readmissions for COPD or other causes was collected at 3 and 12 months after hospital discharge.

Results:  Two sets of 606 and 377 patients were included in the development and validation cohorts, respectively. The CODEX index was associated with mortality at 3 months (P < .0001; hazard ratio [HR], 1.5; 95% CI, 1.2-1.8) and 1 year (P < .0001; HR, 1.3; 95% CI, 1.2-1.5), hospital readmissions in the same periods, and their combination (all P < .0001). All CODEX C statistics were superior to those of the BODEX, DOSE (dyspnea, airflow obstruction, smoking status, and exacerbation frequency), and updated ADO (age, dyspnea, and airflow obstruction) indexes.

Conclusions:  The CODEX index was a useful predictor of survival and readmission at both 3 months and 1 year after hospital discharge for a COPD exacerbation, with a prognostic capacity superior to other previously published indexes.

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