Chest
Original ResearchShort- and Medium-term Prognosis in Patients Hospitalized for COPD Exacerbation: The CODEX Index
Section snippets
Materials and Methods
Data from the EPOC en los Servicios de Medicina Interna (ESMI) study were used for the development of the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index. The ESMI study is a longitudinal, observational, multicenter study conducted in 70 EDs and internal medicine services in Spain. Investigators included the first 10 consecutive patients seen for a severe COPD exacerbation during a 1-year period (October 2009-October 2010). Full methodology is available
Development Cohort
Overall, 679 patients were screened, and 606 were included in the initial ESMI study. Fifteen patients were excluded for having an incomplete minimum dataset, and in another 58 cases, spirometry was unable to be performed or did not fulfill the spirometric criteria for COPD (Fig 1). No differences existed between included and excluded patients with respect to age, sex, smoking history, or dyspnea measured by the mMRC scale (data not shown). Our study included patients hospitalized for
Discussion
Our study, performed in patients hospitalized for AECOPD, has three main findings. First, we demonstrated that a simple index can be useful in predicting survival in both the short and medium term after hospital discharge in these patients. Second, we reported the usefulness of this CODEX index in evaluating the risk of readmission, as well as the composite end point (readmission and/or mortality). Third, we had the opportunity to compare the prognostic validity with other previously validated
Conclusions
In conclusion, the CODEX index is a simple, valid tool for predicting survival and risk of COPD readmission or their combination in patients hospitalized for AECOPD during the year after hospital discharge, and it can be used to assess the severity of COPD in this population. Determining its usefulness in other populations requires further study.
Acknowledgments
Author contributions: Dr Almagro had full access to all the data in the study and takes responsibility for its integrity and the accuracy of the data analysis.
Dr Almagro: contributed to the study design, analysis and interpretation of the data, and writing of the manuscript.
Dr Soriano: contributed to the study design, analysis and interpretation of the data, and writing of the manuscript.
Dr Cabrera: contributed to the data collection and review of the manuscript.
Dr Boixeda: contributed to the
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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.
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