Internal Medicine Service, Hospital Universitario Mutua De Terrassa, Universidad de Barcelona, Barcelona.
Programa de Epidemiología e Investigación Clínica, Fundación Caubet-Cimera, Centro Internacional de Medicina Respiratoria Avanzada, Baleares.
Chest. 2014 May;145(5):972-980. doi: 10.1378/chest.13-1328.
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.
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.
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.
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.
目前尚无有效的工具可用于评估 COPD 患者出院后短期和中期的预后。我们假设，一种基于 CODEX（合并症、阻塞、呼吸困难和既往严重加重）指数的新指数可以准确预测死亡率、再次住院以及这两者在 COPD 住院患者出院后 3 个月至 1 年内的综合情况。
采用多中心 COPD 加重住院患者研究来制定 CODEX 指数，并采用不同的患者队列进行验证。使用年龄调整 Charlson 指数来衡量合并症，而呼吸困难、阻塞和严重加重则根据 BODEX（BMI、气流阻塞、呼吸困难和既往严重加重）阈值来计算。在出院后 3 个月和 12 个月时收集有关 COPD 或其他原因导致的死亡率和再入院的信息。
分别纳入了开发队列和验证队列的 606 例和 377 例患者。CODEX 指数与 3 个月时的死亡率（P <.0001；危险比 [HR]，1.5；95%可信区间，1.2-1.8）和 1 年时的死亡率（P <.0001；HR，1.3；95%可信区间，1.2-1.5）、同期的住院再入院率及其综合情况相关（均 P <.0001）。所有 CODEX 的 C 统计量均优于 BODEX、DOSE（呼吸困难、气流阻塞、吸烟状况和加重频率）和更新的 ADO（年龄、呼吸困难和气流阻塞）指数。
在 COPD 加重住院患者出院后 3 个月和 1 年时，CODEX 指数是一种预测生存率和再入院率的有用指标，其预后能力优于其他已发表的指数。
