Short and Medium Term Prognosis in Patients Hospitalized for Acute Exacerbation of COPD (AECOPD): The CODEX Index

Abstract

SESSION TITLE: COPD PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: To develop and validate a new index to predict mortality, hospital readmission and their combination to 3 and 12 months in patients hospitalized for AECOPD. METHODS: The index was developed using the data of the ESMI study, a multicenter, prospective study of patients hospitalized for AECOPD, conducted in 70 Spanish hospitals. Three previously published cohorts with the same inclusion and exclusion criteria was used for validation. Comorbidity was measured using the age-adjusted Charlson index stratified in tertiles (0-4=0; 5-7=1; ≥8=2), dyspnea, obstruction and exacerbations were calculated to BODE and BODEX thresholds. As a result, possible scores on the newly proposed CODEX index (Comorbidity, Obstruction, Dyspnea and EXacerbations) range from 0 to 10 points. We evaluated the usefulness of CODEX to predict the combined endpoint of mortality or readmission for any cause at 3 and 12 months, and compared with BODEX, DOSE and updated ADO. Time-dependent variables were analyzed with Cox-logistic-regression and Kaplan-Meier statistics. To compare the ability of CODEX to predict all-cause mortality or readmissions with other mortality indices, we plotted Receiver Operating Characteristic curves, and their area under the curve (AUC) was compared with C-statistics. RESULTS: Two sets of 606 and 377 patients were included in the development and validation cohorts, respectively. CODEX was associated with mortality at 3 months, both in development (p<0.0001;HR:1.5;95%:1.2-1.8) and validation cohort(p=0.006;HR:1.4;OR95%:1.1-1.7). AUC was 0.73 for ESMI, 0.71 for the validation, and 0.72 for both cohorts. CODEX was significantly related with mortality at one year in both cohorts, mortality for respiratory causes at one year after discharge (p<0.0001), and hospital readmission at 3-12 months (all p<0.0001). All CODEX C statistics were superior to the BODEX, DOSE, and updated ADO. CONCLUSIONS: The CODEX index was a useful predictor of survival and readmission both at 3 and 12 months after hospital discharge for a AECOPD, with a prognostic capacity superior to other previously published indices. CLINICAL IMPLICATIONS: CODEX can predict accurately mortality, hospital readmission, and their combination at 3 and 12 monts after discharge in patients hospitalized for COPD. DISCLOSURE: The following authors have nothing to disclose: Jordi Juanola Pla, Pedro Almagro Mena, Joan B Soriano, Francico Cabrera, Ramon Boixeda, Maria Belen Alonso Ortiz, Cristina Murio, Jesus Diez, Bienvenido Barreiro, Josep Lluis HerediaNo Product/Research Disclosure Information.