External Validation and Recalculation of the CODEX Index in COPD Patients. A 3CIAplus Cohort Study
Por:
Almagro P, Martínez-Camblor P, Miravitlles M, Rodríguez-Carballeira M, Navarro A, Lamprecht B, Ramirez-Garcia Luna AS, Kaiser B, Alfageme I, Casanova C, Esteban C, Soler-Cataluña JJ, de-Torres JP, Celli BR, Marin JM, Ter Riet G, Sobradillo P, Lange P, Garcia-Aymerich J, Anto JM, Turner AM, Han MK, Langhammer A, Sternberg A, Leivseth L, Bakke P, Johannessen A, Oga T, Cosío B, Ancochea J, Echazarreta A, Roche N, Burgel PR, Sin DD, Puhan MA, Soriano JB and 3CIA collaboration
Publicada:
2 ene 2019
Ahead of Print:
14 mar 2019
Resumen:
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 meanSD 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.
Filiaciones:
Almagro P:
a Multimorbidity Patients Unit, Internal Medicine , Hospital Universitari Mutua de Terrassa, Universitat de Barcelona , Barcelona , Spain
Martínez-Camblor P:
b Geisel School of Medicine at Dartmouth , Hanover , NH , USA
Miravitlles M:
c Pneumology Department , Hospital Universitary Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
Rodríguez-Carballeira M:
a Multimorbidity Patients Unit, Internal Medicine , Hospital Universitari Mutua de Terrassa, Universitat de Barcelona , Barcelona , Spain
Navarro A:
d Pneumology Service , Hospital Universitari Mútua Terrassa , Barcelona , Spain
Lamprecht B:
e Department of Pulmonary Medicine , Kepler-University-Hospital , Linz , Austria
f Faculty of Medicine , Johannes-Kepler-University , Linz , Austria
Ramirez-Garcia Luna AS:
g Facultad de Medicina , Universidad Autónoma de San Luis Potosí , San Luis Potosí , Mexico
Kaiser B:
h Department of Pulmonary Medicine , Paracelsus Medical University Hospital , Salzburg , Austria
Alfageme I:
i Universidad de Sevilla . Departamento de Medicina . HU Virgen de Valme. Sevilla . Spain
Casanova C:
j Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna , Tenerife , Spain
Esteban C:
k Hospital Galdakao-Usansolo , Galdakao , Bizkaia , Spain
:
l Servicio de Neumología , Hospital Arnau de Vilanova , Valencia , Spain
de-Torres JP:
m Clinica Universidad de Navarra , Pamplona , Spain
Celli BR:
n Pulmonary and Critical Care Medicine , Harvard University, Brigham and Women's Hospital , Boston , MA , USA
Marin JM:
o Hospital Universitario Miguel Servet, Zaragoza, and CIBER de Enfermedades Respiratorias (CIBERES) , Spain
Ter Riet G:
p Department of General Practice , Academic Medical Center, University of Amsterdam (AMC) , Amsterdam , The Netherlands
Sobradillo P:
q Hospital Universitario Araba, Sede Txagorritxu, Vitoria, Spain for Universitary Hospital of Cruces in Barakaldo , Spain
Lange P:
r Section of Social Medicine, Department of Public Health , Copenhagen University, Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg , Copenhagen , Denmark
Garcia-Aymerich J:
s ISGlobal , Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain
t Department of Experimental and Health Sciences , Universitat Pompeu Fabra (UPF) , Barcelona , Spain
u CIBER Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain
Anto JM:
s ISGlobal , Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain
t Department of Experimental and Health Sciences , Universitat Pompeu Fabra (UPF) , Barcelona , Spain
u CIBER Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain
Turner AM:
v Institute of Applied Health Research, University of Birmingham , Edgbaston , UK
Han MK:
w Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan , Ann Arbor , MI , USA
Langhammer A:
x Department of Public Health and Nursing , NTNU, Norwegian University of Science and Technology , Trondheim , Norway
Sternberg A:
y Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
Leivseth L:
z Centre for Clinical Documentation and Evaluation , Northern Norway Regional Health Authority , Tromso , Norway
Bakke P:
aa Department of Clinical Science , University of Bergen , Bergen , Norway
Johannessen A:
ab Department of Global Public Health and Primary Care , University of Bergen , Bergen, Bergen , Norway
Oga T:
ac Department of Respiratory Care and Sleep Control Medicine , Kyoto University , Kyoto , Japan
Cosío B:
ad Department of Respiratory Medicine , Hospital Son Espases-IdISPa, Ciberes, Mallorca , Spain
Ancochea J:
ae Servicio de Neumología , Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde , Madrid , Spain
Echazarreta A:
af Servicio de Neumonología , Hospital San Juan de Dios de La Plata , Buenos Aires , Argentina
Roche N:
ag Respiratory Medicine, Cochin Hospital APHP, University Paris Descartes , Paris , France
Burgel PR:
ah James Hogg Research Centre , University of British Columbia , Vancouver , BC , Canada
Sin DD:
ah James Hogg Research Centre , University of British Columbia , Vancouver , BC , Canada
ai Division of Respiratory Medicine, Department of Medicine , St Paul's Hospital , Vancouver , BC , Canada
Puhan MA:
aj Epidemiology , Biostatistics and Prevention Institute, University of Zurich , Zurich , Switzerland
Soriano JB:
ak Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde , Madrid , Spain
Green Published, Green Submitted
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