Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 15

CODEXS: A New Multidimensional Index to Better Predict Frequent COPD Exacerbators with Inclusion of Depression Score

Authors Deng D, Zhou A, Chen P, Shuang Q

Received 6 November 2019

Accepted for publication 21 January 2020

Published 3 February 2020 Volume 2020:15 Pages 249—259


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Chunxue Bai

Dingding Deng, 1,* Aiyuan Zhou, 2–4,* Ping Chen, 2–4 Qingcui Shuang 1

1Department of Respiratory Medicine, First Affiliated People’s Hospital of Shaoyang College, Shaoyang, Hunan 422001, People’s Republic of China; 2Department of Respiratory and Critical Medicine, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, People’s Republic of China; 3Respiratory Disease Research Unit, Central South University, Changsha, Hunan 410011, People’s Republic of China; 4Respiratory Disease Diagnosis and Treatment Center, Central South University, Changsha, Hunan 410011, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Qingcui Shuang
Department of Respiratory Medicine, First Affiliated People’s Hospital of Shaoyang College, West Side of Dongfeng Pedestrian Street, Shuangqing District, Shaoyang, Hunan 422001, People’s Republic of China
Tel +86 136 0739 8125
Fax +86 0739 523 4441
Email [email protected]

Purpose: Depression is reported in association with chronic obstructive pulmonary disease (COPD). However, to date, no multidimensional indices have taken depression into consideration to predict COPD patients’ prognosis. This study aimed to determine whether a new multidimensional index named CODEXS, based on comorbidities, airflow obstruction, dyspnea, previous exacerbation and depression assessed by Self-Rating Depression Scale (SDS), could predict 1-year exacerbations.
Methods: This was a prospective study, patients with stable COPD were used to develop CODEXS at the first visit, and followed up in the 3rd, 6th, and 12th months. After the last visit, patients were divided into frequent and infrequent exacerbators. Another cohort of COPD patients was used for validation. The SDS scoring system in the multidimensional indices ranged from 0 to 4 based on the modified SDS value, representing no depression (25– 39 [0], 40– 49 [1]), mild depression (50– 59), moderate depression (60– 69), and severe depression (≥ 70). Comorbidity, dyspnea, airflow obstruction, and severe exacerbations were calculated according to CODEX thresholds.
Results: Two sets of 105 and 107 patients were recruited in the development and validation cohorts, respectively. Depression was demonstrated as an independent risk factor for frequent exacerbators (odds ratio (OR)=  1.14, 95% confidence interval (CI) =  1.06– 1.23, P <  0.001). The prevalence of depression in frequent exacerbators (35.09%) was higher than that in infrequent exacerbators. CODEXS was significantly associated with exacerbation (OR =2.91; 95% CI, 1.89– 4.48, p< 0.001). Receiver operating characteristic (ROC) curve comparison showed that CODEXS was superior to BODEX(BMI, airflow obstruction, dyspnea, previous exacerbation), BODE (BMI, airflow obstruction, dyspnea, exercise), and updated ADO (age, dyspnea, and airflow obstruction) indices, confirmed by the validation cohort with sensitivity at 85.94% and specificity at 76.74%.
Conclusion: Depression is an independent risk factor for COPD exacerbation. CODEXS is a useful predictor for predicting frequent exacerbators within 1 year and is superior to other previously published indices.

Keywords: COPD, depression, Self-Rating Depression Scale, exacerbation, CODEXS

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]