Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease.

TLDR: A simple disease-specific comorbidities index (COTE) helps assess mortality risk in patients with COPD and increases in the BODE and COTE were independently associated with increased risk of death.

Abstract: Rationale: Patients with chronic obstructive pulmonary disease (COPD) are afflicted by comorbidities. Few studies have prospectively evaluated COPD comorbidities and mortality risk. Objectives: To prospectively evaluate COPD comorbidities and mortality risk. Methods: We followed 1,664 patients with COPD in five centers for a median of 51 months. Systematically, 79 comorbidities were recorded. We calculated mortality risk using Cox proportional hazard, and developed a graphic representation of the prevalence and strengthofassociationtomortalityintheformofa“comorbidome.” A COPD comorbidityindex (COPD specific comorbidity test [COTE]) was constructed based on the comorbidities that increase mortality risk using a multivariate analysis. We tested the COTE index as predictor of mortality and explored whether the COTE index added predictive information when used with the validated BODE index. Measurements and Main Results: Fifteen of 79 comorbidities differed in prevalence between survivors and nonsurvivors. Of those, 12 predictedmortality and were integratedintothe COTE index.Increases in the COTE index were associated with an increased risk of death from COPD-related (hazard ratio [HR], 1.13; 95% confidence interval, 1.08‐1.18; P , 0.001) and non‐COPD-related causes (HR, 1.18; 95%confidenceinterval,1.15‐1.21;P,0.001).Further,increasesin the BODE and COTE were independently associated with increased risk of death. A COTE score of greater than or equal to 4 points increased by 2.2-fold the risk of death (HR, 2.26‐2.68; P , 0.001) in all BODE quartile. Conclusions: Comorbidities are frequent in COPD and 12 of them