1
|
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. External Validation and Recalculation of the CODEX Index in COPD Patients. A 3CIAplus Cohort Study. COPD 2019; 16:8-17. [PMID: 30870059 DOI: 10.1080/15412555.2018.1484440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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.
Collapse
Affiliation(s)
- Pere Almagro
- a Multimorbidity Patients Unit, Internal Medicine , Hospital Universitari Mutua de Terrassa, Universitat de Barcelona , Barcelona , Spain
| | | | - Marc Miravitlles
- c Pneumology Department , Hospital Universitary Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | - Mónica Rodríguez-Carballeira
- a Multimorbidity Patients Unit, Internal Medicine , Hospital Universitari Mutua de Terrassa, Universitat de Barcelona , Barcelona , Spain
| | - Annie Navarro
- d Pneumology Service , Hospital Universitari Mútua Terrassa , Barcelona , Spain
| | - Bernd Lamprecht
- e Department of Pulmonary Medicine , Kepler-University-Hospital , Linz , Austria.,f Faculty of Medicine , Johannes-Kepler-University , Linz , Austria
| | | | - Bernhard Kaiser
- h Department of Pulmonary Medicine , Paracelsus Medical University Hospital , Salzburg , Austria
| | - Inmaculada Alfageme
- i Universidad de Sevilla . Departamento de Medicina . HU Virgen de Valme. Sevilla . Spain
| | - Ciro Casanova
- j Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna , Tenerife , Spain
| | | | | | | | - Bartolome R Celli
- n Pulmonary and Critical Care Medicine , Harvard University, Brigham and Women's Hospital , Boston , MA , USA
| | - Jose M Marin
- o Hospital Universitario Miguel Servet, Zaragoza, and CIBER de Enfermedades Respiratorias (CIBERES) , Spain
| | - Gerben Ter Riet
- p Department of General Practice , Academic Medical Center, University of Amsterdam (AMC) , Amsterdam , The Netherlands
| | - Patricia Sobradillo
- q Hospital Universitario Araba, Sede Txagorritxu, Vitoria, Spain for Universitary Hospital of Cruces in Barakaldo , Spain
| | - Peter Lange
- r Section of Social Medicine, Department of Public Health , Copenhagen University, Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg , Copenhagen , Denmark
| | - Judith Garcia-Aymerich
- 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
| | - Josep M Anto
- 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
| | - Alice M Turner
- v Institute of Applied Health Research, University of Birmingham , Edgbaston , UK
| | - MeiLan K Han
- w Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan , Ann Arbor , MI , USA
| | - Arnulf Langhammer
- x Department of Public Health and Nursing , NTNU, Norwegian University of Science and Technology , Trondheim , Norway
| | - Alice Sternberg
- y Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Linda Leivseth
- z Centre for Clinical Documentation and Evaluation , Northern Norway Regional Health Authority , Tromso , Norway
| | - Per Bakke
- aa Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Ane Johannessen
- ab Department of Global Public Health and Primary Care , University of Bergen , Bergen, Bergen , Norway
| | - Toru Oga
- ac Department of Respiratory Care and Sleep Control Medicine , Kyoto University , Kyoto , Japan
| | - Borja Cosío
- ad Department of Respiratory Medicine , Hospital Son Espases-IdISPa, Ciberes, Mallorca , Spain
| | - Julio Ancochea
- ae Servicio de Neumología , Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde , Madrid , Spain
| | - Andres Echazarreta
- af Servicio de Neumonología , Hospital San Juan de Dios de La Plata , Buenos Aires , Argentina
| | - Nicolas Roche
- ag Respiratory Medicine, Cochin Hospital APHP, University Paris Descartes , Paris , France
| | - Pierre-Régis Burgel
- ah James Hogg Research Centre , University of British Columbia , Vancouver , BC , Canada
| | - Don D Sin
- 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
| | - Milo A Puhan
- aj Epidemiology , Biostatistics and Prevention Institute, University of Zurich , Zurich , Switzerland
| | - Joan B Soriano
- ak Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde , Madrid , Spain
| | | |
Collapse
|