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COPD. 2019 Mar 14:1-10. doi: 10.1080/15412555.2018.1484440. [Epub ahead of print]

External Validation and Recalculation of the CODEX Index in COPD Patients. A 3CIAplus Cohort Study.

Author information

1
a Multimorbidity Patients Unit, Internal Medicine , Hospital Universitari Mutua de Terrassa, Universitat de Barcelona , Barcelona , Spain.
2
b Geisel School of Medicine at Dartmouth , Hanover , NH , USA.
3
c Pneumology Department , Hospital Universitary Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain.
4
d Pneumology Service , Hospital Universitari Mútua Terrassa , Barcelona , Spain.
5
e Department of Pulmonary Medicine , Kepler-University-Hospital , Linz , Austria.
6
f Faculty of Medicine , Johannes-Kepler-University , Linz , Austria.
7
g Facultad de Medicina , Universidad Autónoma de San Luis Potosí , San Luis Potosí , Mexico.
8
h Department of Pulmonary Medicine , Paracelsus Medical University Hospital , Salzburg , Austria.
9
i Universidad de Sevilla . Departamento de Medicina . HU Virgen de Valme. Sevilla . Spain.
10
j Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna , Tenerife , Spain.
11
k Hospital Galdakao-Usansolo , Galdakao , Bizkaia , Spain.
12
l Servicio de Neumología , Hospital Arnau de Vilanova , Valencia , Spain.
13
m Clinica Universidad de Navarra , Pamplona , Spain.
14
n Pulmonary and Critical Care Medicine , Harvard University, Brigham and Women's Hospital , Boston , MA , USA.
15
o Hospital Universitario Miguel Servet, Zaragoza, and CIBER de Enfermedades Respiratorias (CIBERES) , Spain.
16
p Department of General Practice , Academic Medical Center, University of Amsterdam (AMC) , Amsterdam , The Netherlands.
17
q Hospital Universitario Araba, Sede Txagorritxu, Vitoria, Spain for Universitary Hospital of Cruces in Barakaldo , Spain.
18
r Section of Social Medicine, Department of Public Health , Copenhagen University, Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg , Copenhagen , Denmark.
19
s ISGlobal , Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain.
20
t Department of Experimental and Health Sciences , Universitat Pompeu Fabra (UPF) , Barcelona , Spain.
21
u CIBER Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain.
22
v Institute of Applied Health Research, University of Birmingham , Edgbaston , UK.
23
w Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan , Ann Arbor , MI , USA.
24
x Department of Public Health and Nursing , NTNU, Norwegian University of Science and Technology , Trondheim , Norway.
25
y Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
26
z Centre for Clinical Documentation and Evaluation , Northern Norway Regional Health Authority , Tromso , Norway.
27
aa Department of Clinical Science , University of Bergen , Bergen , Norway.
28
ab Department of Global Public Health and Primary Care , University of Bergen , Bergen, Bergen , Norway.
29
ac Department of Respiratory Care and Sleep Control Medicine , Kyoto University , Kyoto , Japan.
30
ad Department of Respiratory Medicine , Hospital Son Espases-IdISPa, Ciberes, Mallorca , Spain.
31
ae Servicio de Neumología , Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde , Madrid , Spain.
32
af Servicio de Neumonología , Hospital San Juan de Dios de La Plata , Buenos Aires , Argentina.
33
ag Respiratory Medicine, Cochin Hospital APHP, University Paris Descartes , Paris , France.
34
ah James Hogg Research Centre , University of British Columbia , Vancouver , BC , Canada.
35
ai Division of Respiratory Medicine, Department of Medicine , St Paul's Hospital , Vancouver , BC , Canada.
36
aj Epidemiology , Biostatistics and Prevention Institute, University of Zurich , Zurich , Switzerland.
37
ak Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde , Madrid , Spain.

Abstract

The CODEX index was developed and validated in patients hospitalized for COPD exacerbation to predict the risk of death and readmission within one year after discharge. Our study aimed to validate the CODEX index in a large external population of COPD patients with variable durations of follow-up. Additionally, we aimed to recalculate the thresholds of the CODEX index using the cutoffs of variables previously suggested in the 3CIA study (mCODEX). Individual data on 2,755 patients included in the COPD Cohorts Collaborative International Assessment Plus (3CIA+) were explored. A further two cohorts (ESMI AND EGARPOC-2) were added. To validate the CODEX index, the relationship between mortality and the CODEX index was assessed using cumulative/dynamic ROC curves at different follow-up periods, ranging from 3 months up to 10 years. Calibration was performed using univariate and multivariate Cox proportional hazard models and Hosmer-Lemeshow test. A total of 3,321 (87.8% males) patients were included with a mean ± SD age of 66.9 ± 10.5 years, and a median follow-up of 1,064 days (IQR 25-75% 426-1643), totaling 11,190 person-years. The CODEX index was statistically associated with mortality in the short- (≤3 months), medium- (≤1 year) and long-term (10 years), with an area under the curve of 0.72, 0.70 and 0.76, respectively. The mCODEX index performed better in the medium-term (<1 year) than the original CODEX, and similarly in the long-term. In conclusion, CODEX and mCODEX index are good predictors of mortality in patients with COPD, regardless of disease severity or duration of follow-up.

KEYWORDS:

COPD; Prognosis; comorbidities; mortality; multicomponent index; survival

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