Short- and medium-term prognosis in patients hospitalized for COPD exacerbation: the CODEX index.
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, airfl ow 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, airfl ow obstruction, smoking status, and exacerbation frequency), and updated ADO (age, dyspnea, and airfl ow 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.
Internal Medicine Service, Hospital Universitario Mutua De Terrassa, Universidad de Barcelona, Barcelona. Electronic address: 19908pam@comb.cat.
Pedro
P
Almagro
Programa de Epidemiología e Investigación Clínica, Fundación Caubet-Cimera, Centro Internacional de Medicina Respiratoria Avanzada, Baleares.
Joan B
JB
Soriano
Internal Medicine Service, Hospital General Universitario Gregorio Marañón, Madrid.
Francisco J
FJ
Cabrera
Internal Medicine Service, Hospital de Mataró, Barcelona.
Ramon
R
Boixeda
Internal Medicine Service, Hospital Juan Negrín, Gran Canaria.
M Belen
MB
Alonso-Ortiz
Respiratory Service, Hospital Universitario Mutua De Terrassa, Universidad de Barcelona, Barcelona.
Bienvenido
B
Barreiro
Internal Medicine Service, Hospital Royo Villanova, Zaragoza, Spain.
Jesus
J
Diez-Manglano
Medical Department, Laboratorios Chiesi, Barcelona.
Cristina
C
Murio
Respiratory Service, Hospital Universitario Mutua De Terrassa, Universidad de Barcelona, Barcelona.
Josep L
JL
Heredia
D000368:Aged; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology; D018450:Disease Progression; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D010351:Patient Discharge / Q000639:trends*; D010359:Patient Readmission / Q000639:trends; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors