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De este modo&#44; la &#250;ltima normativa de la <span class="elsevierStyleItalic">Global Obstructive Lung Disease</span> &#40;GOLD&#41; combina estas 3 variables para clasificar la EPOC en 4 grupos de menor a mayor gravedad&#58; A&#44; B&#44; C y D<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a>&#46; Esta nueva clasificaci&#243;n GOLD puede considerarse una escala multicomponente cuya validaci&#243;n ha generado un importante debate<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Otros &#237;ndices multidimensionales desarrollados en la &#250;ltima d&#233;cada han demostrado una mejor predicci&#243;n de la mortalidad y del riesgo de exacerbaciones que el FEV<span class="elsevierStyleInf">1</span> aislado&#46; De ellos el m&#225;s validado y el que ha mostrado mayor precisi&#243;n es el &#237;ndice BODE&#44; compuesto de 4 variables estratificadas en diferentes puntos de corte&#58; &#237;ndice de masa corporal &#8212;IMC&#8212; &#40;B&#41;&#44; FEV<span class="elsevierStyleInf">1</span> posbroncodilataci&#243;n &#40;O&#41;&#44; disnea &#40;D&#41; y la distancia recorrida en el test de la marcha de 6&#160;min &#40;E&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a>&#46; Sus limitaciones son que requiere realizar un test de la marcha&#44; por lo que no es practicable en pacientes con limitaciones de la deambulaci&#243;n&#44; y la dificultad de su implementaci&#243;n en atenci&#243;n primaria&#46; Adem&#225;s&#44; el BODE fue desarrollado en pacientes ambulatorios con EPOC y poca comorbilidad&#46; M&#225;s recientemente se han desarrollado otros &#237;ndices multicomponente que no precisan la realizaci&#243;n del test de la marcha y que han demostrado su utilidad en diferentes poblaciones con EPOC&#44; como el BODEX &#40;sustituye el test de la marcha por la historia de exacerbaciones graves en el a&#241;o previo&#41;&#44; ADO &#40;edad&#58; A&#44; disnea&#58; D&#44; obstrucci&#243;n&#58; O&#41; o DOSE &#40;disnea&#58; D&#44; obstrucci&#243;n&#58; O&#44; tabaquismo&#58; S&#44; exacerbaciones&#58; E&#41; entre otros&#44; aunque ninguno de ellos analiza la presencia de comorbilidades&#44; frecuentes y con importantes connotaciones pron&#243;sticas en la EPOC<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#8211;12</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En el a&#241;o 2014 se public&#243; el desarrollo y validaci&#243;n del &#237;ndice CODEX<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a>&#46; El CODEX utiliza los mismos puntos de corte para la obstrucci&#243;n pulmonar &#40;O&#41;&#44; la disnea &#40;D&#41; y las exacerbaciones en el a&#241;o previo &#40;EX&#41; que el BODEX&#44; sustituyendo el IMC &#40;B&#41; por el &#237;ndice de Charlson ajustado por edad<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a>&#46; El CODEX demostr&#243; en su publicaci&#243;n original una mejor capacidad pron&#243;stica sobre el resto de &#237;ndices respecto a mortalidad y reingresos hospitalarios en pacientes ingresados por EPOC a 3 meses y un a&#241;o<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a>&#46; Para su desarrollo se utiliz&#243; una cohorte de pacientes hospitalizados por exacerbaci&#243;n de EPOC en 70 servicios de Medicina Interna espa&#241;oles &#8212;estudio ESMI&#8212; realizado por el grupo de trabajo de EPOC de la SEMI<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a>&#46; Su validaci&#243;n y desarrollo se realiz&#243; en otras 3 cohortes<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">15&#8211;20</span></a>&#46; Sin embargo&#44; este &#237;ndice no ha sido testado en otras poblaciones y&#44; en el trabajo original&#44; el seguimiento se limit&#243; a un a&#241;o&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nuestro objetivo es valorar la utilidad del &#237;ndice CODEX en una poblaci&#243;n de pacientes ambulatorios con EPOC avanzada a m&#225;s largo plazo &#8212;hasta 800 d&#237;as&#8212; y compararlo con otros &#237;ndices como el BODEX o la clasificaci&#243;n GOLD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se incluy&#243; a todos los pacientes con EPOC controlados por la Unidad Funcional de Enfermos Cr&#243;nicos Respiratorios del Hospital Universitario Mutua de Terrassa &#40;Barcelona&#41;&#44; entre junio del 2012 y junio del 2014&#46; Esta unidad eval&#250;a peri&#243;dicamente a los pacientes con enfermedades respiratorias graves y alto riesgo de descompensaciones&#46; Se recogieron prospectivamente una espirometr&#237;a posbroncodilataci&#243;n&#44; la escala de disnea modificada del <span class="elsevierStyleItalic">Medical Research Council</span> &#40;mMRC&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a>&#44; el cuestionario de calidad de vida <span class="elsevierStyleItalic">COPD assessment test</span> &#40;CAT&#41;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">22</span></a>&#44; el tratamiento prescrito para la EPOC&#44; la historia de exacerbaciones y hospitalizaciones por EPOC en el &#250;ltimo a&#241;o y la comorbilidad utilizando el &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a>&#46; Los pacientes se clasificaron siguiendo la normativa GOLD &#40;A-D&#41; y de acuerdo con el BODEX con los puntos de corte establecidos&#46; Para el c&#225;lculo del &#237;ndice CODEX se sustituy&#243; el IMC del BODEX por el &#237;ndice de Charlson corregido por edad&#44; a&#241;adiendo un punto por cada d&#233;cada de edad a partir de los 50 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a>&#46; Finalmente la puntuaci&#243;n obtenida para el Charlson se estratific&#243; de acuerdo con el estudio original &#40;0-4&#160;&#61;&#160;0&#59; 5-7&#160;&#61;&#160;1&#59; &#8805;8&#160;&#61;&#160;2&#41;&#44; por lo que las puntuaciones posibles en el &#237;ndice CODEX pod&#237;an oscilar entre 0 y 10 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Los datos de seguimiento se obtuvieron de la historia cl&#237;nica electr&#243;nica y mediante llamadas telef&#243;nicas&#46; Todos los pacientes fueron controlados por el mismo facultativo y la misma enfermera especialista de acuerdo con las normativas de tratamiento de la gu&#237;a GesEPOC<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se evalu&#243; el tiempo hasta el fallecimiento&#44; la primera exacerbaci&#243;n y el primer ingreso hospitalario&#44; as&#237; como una variable combinada definida como muerte o ingreso hospitalario por exacerbaci&#243;n de EPOC&#46; Se realiz&#243; tambi&#233;n un an&#225;lisis por eventos individualizados utilizando la variable combinada&#46; El tiempo se calcul&#243; desde la primera visita en la unidad hasta la fecha del primer evento &#40;muerte&#44; reingreso o su combinaci&#243;n&#41;&#44; mientras que en el an&#225;lisis por eventos fue el transcurrido desde la primera visita en la unidad hasta cada uno de los eventos&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables cuantitativas se expresan como medias y desviaci&#243;n est&#225;ndar &#40;DE&#41; y su an&#225;lisis se realiz&#243; mediante la t de Student o la U de Mann-Whitney de acuerdo con su distribuci&#243;n&#46; Las variables cualitativas se detallan como n&#250;mero y porcentaje y se analizaron con la prueba de Ji cuadrado&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para las variables tiempo-dependientes se utilizaron las curvas de Kaplan-Meier y el an&#225;lisis de riesgos proporcionales de Cox&#46; Cuando en el estudio bivariado ambos &#237;ndices &#40;CODEX y BODEX&#41; mostraron asociaci&#243;n estad&#237;stica significativa&#44; se construyeron modelos multivariantes de riesgos proporcionales de Cox&#44; introduciendo ambos &#237;ndices junto a su interacci&#243;n&#46; Se calcularon las curvas <span class="elsevierStyleItalic">Receiver Operating Characteristic</span> &#40;ROC&#41;&#44; compar&#225;ndose el &#225;rea bajo la curva &#40;AUC&#41; del estad&#237;stico C para los diferentes &#237;ndices y analizando su significaci&#243;n con el m&#233;todo DeLong<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El estudio se realiz&#243; dentro de la pr&#225;ctica cl&#237;nica habitual y fue aprobado por el Comit&#233; de Ensayos Cl&#237;nicos del Hospital Mutua de Terrassa&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se incluy&#243; a 80 pacientes &#40;90&#37; varones&#41; con una edad media de 73&#44;4 &#40;DE&#58; 8&#44;9&#41; a&#241;os y un FEV<span class="elsevierStyleInf">1</span> tras la prueba broncodilatadora del 39&#37; &#40;DE&#58;&#160;16&#37;&#41;&#46; La media obtenida en el &#237;ndice de Charlson fue de 2&#44;96 &#40;DE&#58;&#160;1&#44;5&#41; sin ajustar por la edad y de 4&#44;92 &#40;DE&#58;&#160;1&#44;9&#41; considerando dicho par&#225;metro&#46; La mediana de seguimiento fue de 650 d&#237;as con un rango intercuart&#237;lico &#40;25-75&#37;&#41; de 384-752 d&#237;as&#46; Durante este tiempo se produjeron 17 fallecimientos &#40;21&#37;&#41;&#46; Las caracter&#237;sticas de la poblaci&#243;n de acuerdo con la mortalidad se exponen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; El &#237;ndice CODEX se asoci&#243; significativamente a la mortalidad &#40;p&#160;&#61;&#160;0&#44;008&#59; HC&#58;1&#44;56&#59; IC&#160;95&#37;&#58;1&#44;12-2&#44;15&#41;&#44; mientras que no lo hicieron la clasificaci&#243;n GOLD ni el &#237;ndice BODEX &#40;p&#160;&#61;&#160;0&#44;07&#41;&#46; El &#225;rea bajo la curva &#40;AUC&#41; fue de 0&#44;77 &#40;IC 95&#37;&#58; 0&#44;6-0-83&#41; para el CODEX y de 0&#44;63 &#40;IC&#160;95&#37;&#58; 0&#44;52-0&#44;74&#41; para el BODEX &#40;p&#160;&#60;&#160;0&#44;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Un 71&#37; de los pacientes presentaron al menos una exacerbaci&#243;n ambulatoria con una media de 1&#44;9 &#40;DE&#58; 1&#44;2&#41; episodios&#46; Ninguno de los &#237;ndices se asoci&#243; significativamente con la presencia de exacerbaciones ambulatorias durante el seguimiento&#46; Un total de 58 pacientes &#40;72&#44;5&#37;&#41; requirieron al menos un ingreso hospitalario por exacerbaci&#243;n de EPOC durante el seguimiento con una media de ingresos de 2 &#40;DE&#58; 2&#44;21&#41;&#46; En el estudio bivariante&#44; el &#237;ndice CODEX se asoci&#243; significativamente al riesgo de hospitalizaci&#243;n &#40;p&#160;&#60;&#160;0&#44;001&#59; HR&#58; 1&#44;41&#59; IC&#160;95&#37;&#58; 1&#44;16-1-72&#41; as&#237; como el BODEX &#40;p&#160;&#60;&#160;0&#44;03&#59; HR&#58; 1&#44;19&#59; IC&#160;95&#37;&#58; 1&#44;02-1&#44;34&#41;&#44; mientras que la clasificaci&#243;n GOLD no mostr&#243; significaci&#243;n estad&#237;stica&#46; El AUC fue similar en el CODEX &#40;0&#44;70&#41; y el BODEX &#40;0&#44;69&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Al analizar la relaci&#243;n con la variable combinada&#44; de nuevo los &#237;ndices CODEX &#40;p&#160;&#61;&#160;0&#44;003&#59; HC&#58; 1&#44;27&#59; IC&#160;95&#37;&#58; 1&#44;1-1&#44;5&#41; y BODEX &#40;p&#160;&#61;&#160;0&#44;03&#59; HC&#58; 1&#44;19&#59; IC&#160;95&#37;&#58; 1&#44;02-1&#44;34&#41; mostraron una relaci&#243;n estad&#237;sticamente significativa&#44; sin diferencias en el AUC &#40;0&#44;65 y 0&#44;62&#44; respectivamente&#41;&#44; mientras que la clasificaci&#243;n GOLD mostr&#243; una p de 0&#44;049&#46; Tras ajustar ambos &#237;ndices y su interacci&#243;n en un modelo multivariante de riesgos proporcionales de Cox solo el CODEX conserv&#243; una relaci&#243;n independiente con la variable combinada &#40;p&#160;&#60;&#160;0&#44;03&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; La relaci&#243;n entre la variable combinada con el CODEX estratificado en terciles se representa gr&#225;ficamente en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Durante el seguimiento se produjeron 187 eventos&#46; Tanto el &#237;ndice CODEX &#40;p&#160;&#60;&#160;0&#44;001&#59; HC&#58; 1&#44;17&#59; IC&#160;95&#37;&#58; 1&#44;1-1&#44;27&#41; como el BODEX &#40;p&#160;&#60;&#160;0&#44;02&#59; HC&#58; 1&#44;12&#59; IC&#160;95&#37;&#58; 1&#44;02-1&#44;23&#41; se asociaron al n&#250;mero total de eventos&#44; mientras que la nueva clasificaci&#243;n GOLD no mostr&#243; significaci&#243;n&#46; Las curvas por eventos agrupados por terciles del CODEX se muestran en la <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a>&#46; La relaci&#243;n entre los diferentes componentes del CODEX y BODEX respecto a la mortalidad&#44; la variable combinada y el an&#225;lisis por eventos&#44; se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#44; mientras que la comparaci&#243;n entre el n&#250;mero de eventos y el CODEX estratificado se representa en la <a class="elsevierStyleCrossRef" href="#fig0020">figura 4</a>&#46; Al ajustar el n&#250;mero de eventos en la regresi&#243;n de Cox para CODEX y BODEX&#44; a&#241;adiendo la interacci&#243;n entre ellos&#44; solo el CODEX conserv&#243; la significaci&#243;n estad&#237;stica &#40;p&#160;&#60;&#160;0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">La escala de calidad de vida relacionada con la salud CAT no mostr&#243; relaci&#243;n con la mortalidad&#44; el n&#250;mero de ingresos ni la variable combinada&#46; En 50 pacientes &#40;62&#37;&#41; no se realiz&#243; el test de la marcha&#44; por lo que no se estudi&#243; la relaci&#243;n del BODE con mortalidad&#44; reingresos o la variable combinada&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nuestro estudio confirma la validez del &#237;ndice CODEX para la valoraci&#243;n pron&#243;stica de los pacientes con EPOC&#44; utilizando una poblaci&#243;n diferente a la incluida en el trabajo original realizado en pacientes hospitalizados por exacerbaci&#243;n y con un mayor periodo de seguimiento&#46; Hasta donde sabemos&#44; este es el primer estudio en que se confirma la validez de este &#237;ndice tras su publicaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">13&#44;25</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La valoraci&#243;n pron&#243;stica de la EPOC ha sido objeto de estudio en diferentes publicaciones<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a>&#46; El BODE fue el primer &#237;ndice cl&#237;nicamente &#250;til para evaluar el pron&#243;stico de estos pacientes&#44; mediante 4 variables estratificadas&#58; IMC &#40;B&#41;&#44; FEV<span class="elsevierStyleInf">1</span> posbroncodilataci&#243;n &#40;O&#41;&#44; disnea &#40;D&#41; y la distancia recorrida en el test de la marcha de 6&#160;min &#40;E&#41;&#44; y se ha validado en m&#250;ltiples estudios posteriores&#44; incluyendo poblaci&#243;n hospitalizada<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7&#44;20</span></a>&#46; M&#225;s recientemente se han desarrollado otros &#237;ndices multicomponente en diferentes poblaciones&#46; El primero de ellos fue el denominado &#237;ndice BODEX en el que el test de la marcha se sustituy&#243; por la historia de exacerbaciones graves en el a&#241;o previo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a>&#46; El DOSE &#40;disnea&#44; obstrucci&#243;n&#44; tabaquismo y exacerbaciones&#41; fue dise&#241;ado para predecir exacerbaciones&#44; aunque tambi&#233;n se ha relacionado con la mortalidad y se ha implementado sobre todo en atenci&#243;n primaria<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#44;27</span></a>&#46; El ADO &#40;edad&#44; disnea y FEV<span class="elsevierStyleInf">1</span>&#41; tambi&#233;n ha demostrado una buena fiabilidad pron&#243;stica&#44; si bien algunos autores cuestionan el peso de la edad en este &#237;ndice&#44; ya que&#44; a pesar de ser un excelente predictor de mortalidad&#44; no es modificable<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">9&#44;11&#44;28&#44;29</span></a>&#46; Todos estos &#237;ndices han sido desarrollados en poblaciones con EPOC ambulatoria&#44; excepto una nueva escala &#40;DECAF&#58; disnea&#44; eosinopenia&#44; condensaci&#243;n&#44; acidemia y fibrilaci&#243;n auricular&#41; dise&#241;ada para valorar la mortalidad intrahospitalaria en pacientes con EPOC&#44; que excluy&#243;&#44; sin embargo&#44; a pacientes con comorbilidad grave<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A pesar del reconocido impacto de la comorbilidad en la EPOC&#44; ninguna de estas escalas pron&#243;sticas incorpora su valoraci&#243;n&#59; antes bien&#44; excluyen a los pacientes con enfermedades asociadas graves&#44; por lo que pueden no representar a la poblaci&#243;n habitualmente hospitalizada por exacerbaci&#243;n de EPOC&#44; en la que la plurienfermedad es la regla y se relaciona estrechamente con el pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a>&#46; Con este objetivo se dise&#241;&#243; y valid&#243; el &#237;ndice CODEX en pacientes hospitalizados por EPOC y que incorpora la comorbilidad&#46; Este &#237;ndice demostr&#243; en su publicaci&#243;n original una mejor calibraci&#243;n para predecir reingresos y mortalidad al a&#241;o en esta poblaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a>&#46; El presente estudio confirma estos hallazgos en una poblaci&#243;n diferente y con un mayor plazo de seguimiento&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En la cohorte analizada en nuestro trabajo&#44; el &#237;ndice CODEX es superior al BODEX en la valoraci&#243;n del riesgo de mortalidad&#44; en la variable combinada &#40;tras ajustarlo por variables de confusi&#243;n&#41; y en el an&#225;lisis por eventos&#46; No obstante&#44; el &#237;ndice BODEX tambi&#233;n demuestra una relaci&#243;n estad&#237;sticamente significativa con la variable combinada y el an&#225;lisis por eventos&#44; por lo que no se puede discutir su utilidad y sigue siendo una alternativa al BODE en los casos en que no est&#233; disponible el test de la marcha<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a>&#46; La &#250;nica diferencia entre CODEX y BODEX es la sustituci&#243;n del IMC por el &#237;ndice de Charlson ajustado por edad&#46; Aunque tanto el bajo peso como la comorbilidad se asocian a un peor pron&#243;stico en la EPOC&#44; esta &#250;ltima parece tener m&#225;s importancia en el riesgo de muerte y hospitalizaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">15&#44;31</span></a>&#46; De hecho&#44; como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#44; el IMC estratificado para el BODEX no alcanz&#243; significaci&#243;n estad&#237;stica en ninguno de los an&#225;lisis realizados&#44; contrariamente a lo observado con el &#237;ndice de Charlson&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Creemos que la utilidad de los diversos &#237;ndices depende en gran parte de la poblaci&#243;n analizada y de los objetivos del estudio&#46; Por ejemplo&#44; el BODE es m&#225;s sensible a los cambios despu&#233;s de una exacerbaci&#243;n o con la rehabilitaci&#243;n respiratoria y es el de elecci&#243;n para valorar los resultados de un programa de rehabilitaci&#243;n pulmonar<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a>&#46; En poblaci&#243;n ambulatoria con poca comorbilidad el BODEX es m&#225;s sencillo de calcular que el BODE&#46; Por el contrario en poblaci&#243;n hospitalizada con comorbilidad a&#241;adida el CODEX es posiblemente mejor escala pron&#243;stica&#46; Recientemente un documento de consenso entre las sociedades europeas y americana de respiratorio se&#241;ala como un objetivo de investigaci&#243;n prioritario la realizaci&#243;n de estudios comparativos entre los diversos &#237;ndices pron&#243;sticos de la EPOC<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Finalmente&#44; debemos destacar que en nuestra poblaci&#243;n ni la escala GOLD ni el &#237;ndice CAT han demostrado utilidad en la valoraci&#243;n del riesgo de mortalidad ni de hospitalizaciones&#46; Diversos estudios han reportado las limitaciones de la escala GOLD como predictora de mortalidad<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a>&#46; De hecho&#44; la supervivencia es menor en los pacientes del grupo B &#40;menos grave&#41; que en los del grupo C &#40;m&#225;s graves&#41;&#44; lo que indica que el grupo B incluye pacientes con menor afectaci&#243;n espirom&#233;trica&#44; pero m&#225;s comorbilidades y&#44; por tanto&#44; peor pron&#243;stico&#46; Por su parte&#44; la normativa GOLD considera que la valoraci&#243;n de s&#237;ntomas puede realizarse utilizando indistintamente la escala de disnea del mMRC o el CAT&#46; Sin embargo&#44; el uso de una u otra escala modifica la categor&#237;a de gravedad en la que se clasifica a los pacientes y&#44; adem&#225;s&#44; contrariamente a la escala de disnea del mMRC&#44; el CAT no ha demostrado relaci&#243;n con la mortalidad<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3&#44;34&#44;35</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene limitaciones&#46; En primer lugar&#44; el tama&#241;o de la muestra&#46; Aunque el n&#250;mero de pacientes incluidos y el seguimiento han sido suficientes para demostrar la validez del CODEX&#44; dado el elevado n&#250;mero de fallecimientos y hospitalizaciones&#44; algunas variables podr&#237;an haber alcanzado significaci&#243;n estad&#237;stica con un mayor tama&#241;o muestral&#46; El escaso n&#250;mero de mujeres incluidas es com&#250;n a todos los estudios realizados en Espa&#241;a&#44; pero limita la extrapolaci&#243;n de los resultados a otras poblaciones<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; nuestro estudio refuerza la utilidad del &#237;ndice CODEX en la valoraci&#243;n pron&#243;stica de los pacientes con EPOC avanzada&#44; aunque requerir&#225; de nuevas validaciones en otros estudios&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0120" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2015-04-22"
    "fechaAceptado" => "2015-06-02"
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            0 => "Enfermedad pulmonar obstructiva cr&#243;nica"
            1 => "Pron&#243;stico"
            2 => "Mortalidad"
            3 => "Hospitalizaci&#243;n"
            4 => "Comorbilidad"
            5 => "Multimorbilidad"
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            0 => "Chronic Obstructive Pulmonary disease"
            1 => "Prognosis"
            2 => "Mortality"
            3 => "Hospitalisation"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Validar el &#237;ndice CODEX en pacientes ambulatorios con EPOC avanzada&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a todos los pacientes con EPOC controlados en una unidad de pacientes cr&#243;nicos respiratorios&#46; Se calcularon los &#237;ndices BODEX y CODEX y su relaci&#243;n con mortalidad&#44; hospitalizaciones o ambas&#44; y se realiz&#243; un an&#225;lisis por n&#250;mero de eventos &#40;mortalidad o reingresos&#41;&#44; mediante el an&#225;lisis de riesgos proporcionales de Cox&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 80 pacientes &#40;90&#37; varones&#41; con una edad media de 73&#44;4 a&#241;os&#46; El seguimiento medio fue de 656 d&#237;as con un rango intercuart&#237;lico &#40;25-75&#37;&#41; de 417-642 d&#237;as&#46; Un total de 17 pacientes fallecieron &#40;21&#37;&#41; y 57 &#40;71&#44;3&#37;&#41; requirieron hospitalizaci&#243;n por EPOC&#46; El &#237;ndice CODEX se relacion&#243; significativamente con la mortalidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#59; HR&#58;&#160;1&#44;56&#59; IC&#160;95&#37;&#58; 1&#44;1-2&#44;15&#41;&#44; el ingreso hospitalario &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; HR&#58; 1&#44;35&#59; IC&#160;95&#37;&#58; 1&#44;13-1&#44;62&#41; y la variable combinada &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#59; HR&#58; 1&#44;27&#59; IC&#160;95&#37;&#58; 1&#44;1-1&#44;5&#41;&#46; El BODEX no se asoci&#243; con la mortalidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;17&#41;&#44; pero s&#237; con los ingresos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; HR&#58; 1&#44;4&#59; IC&#160;95&#37;&#58; 1&#44;15-1&#44;73&#41; y la variable combinada &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#59; HR&#58; 1&#44;2&#59; IC&#160;95&#37;&#58; 1&#44;02-1&#44;34&#41;&#46; Durante el seguimiento se produjeron 187 eventos&#46; Tanto el &#237;ndice CODEX &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; HR&#58;1&#44;17&#59; IC&#160;95&#37;&#58;1&#44;1-1&#44;27&#41; como el BODEX &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#59; HR&#58; 1&#44;12&#59; IC&#160;95&#37;&#58; 1&#44;02-1&#44;23&#41; se relacionaron con el n&#250;mero de eventos&#44; aunque tras ajustar por la interacci&#243;n entre ambos &#237;ndices solo el CODEX conserv&#243; la significaci&#243;n estad&#237;stica para la variable combinada por pacientes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; y en el an&#225;lisis por n&#250;mero de eventos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Tanto el CODEX como el BODEX son &#250;tiles en la predicci&#243;n de ingresos hospitalarios&#44; aunque la capacidad pron&#243;stica del CODEX es superior al BODEX tanto en mortalidad como en ingresos hospitalarios&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To validate the CODEX index in outpatients with advanced chronic obstructive pulmonary disease &#40;COPD&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We studied all patients with COPD treated in a chronic respiratory disease unit&#46; We calculated the BODEX and CODEX indices and their relationship with mortality&#44; hospitalisations or both and performed an analysis by number of events &#40;mortality and&#47;or readmissions&#41;&#44; using the Cox proportional hazards analysis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We included 80 patients &#40;90&#37; men&#41; with a mean age of 73&#46;4 years&#46; The mean follow-up was 656 days&#44; with an interquartile range &#40;25-75&#37;&#41; of 417-642 days&#46; Seventeen patients died &#40;21&#37;&#41; and 57 &#40;71&#46;3&#37;&#41; required hospitalisation for COPD&#46; The CODEX index was significantly related to mortality &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;008&#59; HR&#58; 1&#46;56&#59; 95&#37; CI&#58; 1&#46;1&#8211;2&#46;15&#41;&#44; hospitalisations &#40;P&#60;&#46;01&#59; HR&#58; 1&#46;35&#59; 95&#37; CI&#58; 1&#46;13&#8211;1&#46;62&#41; and the combined variable &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;03&#59; HR&#58; 1&#46;27&#59; 95&#37; CI&#58; 1&#46;1&#8211;1&#46;5&#41;&#46; The BODEX index was not associated with mortality &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;17&#41; but was associated with hospitalisation &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#59; HR&#58; 1&#46;4&#59; 95&#37; CI&#58; 1&#46;15&#8211;1&#46;73&#41; and the combined variable &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;03&#59; HR&#58; 1&#46;2&#59; 95&#37; CI&#58; 1&#46;02&#8211;1&#46;34&#41;&#46; There were 187 events during follow-up&#46; Both the CODEX &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#59; HR&#58; 1&#46;17&#59; 95&#37; CI&#58; 1&#46;1&#8211;1&#46;27&#41; and BODEX &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;02&#59; HR&#58; 1&#46;12&#59; 95&#37; CI&#58; 1&#46;02&#8211;1&#46;23&#41; indices were related to the number of events&#46; However&#44; after adjusting for the interaction between the 2 indices&#44; only the CODEX index maintained statistical significance for the combined variable for patients &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;03&#41; and in the analysis by number of events &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Both the CODEX and BODEX indices are useful for predicting hospitalisations&#44; although the prognostic ability of the CODEX index is greater than that of the BODEX index&#44; both for mortality and hospitalisations&#46;</p></span>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CODEX&#58; comorbilidad&#44; obstrucci&#243;n&#44; disnea&#44; exacerbaciones&#59; mMRC&#58; escala de disnea modificada de Medical Research Council&#59; PBD&#58; posbroncodilataci&#243;n&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dominio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Comorbilidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Obstrucci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>&#37; PBD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50-64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36-49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8804;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">mMRC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">EX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exacerbaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Exacerbaciones<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0010"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Exacerbaciones graves en el &#250;ltimo a&#241;o &#40;ingreso hospitalario o visita en urgencias por exacerbaci&#243;n de EPOC&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis se realiz&#243; mediante comparaci&#243;n de medias o Ji cuadrado&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">LABA&#58; betamim&#233;ticos de larga duraci&#243;n&#59; LAMA&#58; anticolin&#233;rgicos de larga duraci&#243;n&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fallecidos &#40;n&#160;&#61;&#160;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vivos &#40;n &#61; 63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total &#40;n&#160;&#61;&#160;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sexo &#40;var&#243;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;90&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#44;1 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#44;1 &#40;8&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;4 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><span class="elsevierStyleItalic">&#37; &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#44;6 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#44;6 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">FVC &#37; &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">FEV</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">1</span></span><span class="elsevierStyleItalic">&#47;FVC &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;2 &#40;11&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#44;6 &#40;12&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Disnea &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;9 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;6 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;7 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="char" valign="top"><span class="elsevierStyleItalic">Tabaquismo</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Actual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Exfumador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;91&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Paquetes-a&#241;o<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;8 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;7 &#40;33&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#44;2 &#40;35&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">CAT &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#44;2 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;1 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">IMC &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#44;8 &#40;4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#44;7 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#44;1 &#40;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Ingresos &#40;DE&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;4 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;7 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;1 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Charlson sin edad &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;7 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Charlson con edad &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;3 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;6 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;9 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">BODEX &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;6 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;9 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;1 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">CODEX &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;7 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;5 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;8 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">GOLD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;22&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;21&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;82&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;73&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="char" valign="top"><span class="elsevierStyleItalic">F&#225;rmacos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Corticoides inhalados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;98&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LABA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LAMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Roflumilast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;15&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Teofilina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;9&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Azitromicina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;31&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;31&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;31&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>N&#250;mero de f&#225;rmacos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;3 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#44;2 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#44;4 &#40;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Variable combinada</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1-4&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;47-1&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CODEX&#42;BODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;85-1&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">An&#225;lisis por eventos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;29-2&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;68-1&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CODEX&#42;BODEX&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;9-1&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mortalidad</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;4-7&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">C</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;49-7&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">O</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;78-2&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">D</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;69-3&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">EX</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">BODEX</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;97-1&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">CODEX</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;12-2&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Combinada</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;17-1&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;94-2&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;89-1&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;86-2&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1-2&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;02-1&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;08-1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="char" valign="top"><span class="elsevierStyleItalic">Eventos</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;5-1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;13-1&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;93-1&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;96-1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;16-1&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;02-1&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CODEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;07-1&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de los diferentes componentes de BODEX y CODEX</p>"
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                            2 => "P&#46; Rom&#225;n S&#225;nchez"
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                            4 => "C&#46; Esteban"
                            5 => "J&#46;J&#46; Soler-Catalu&#241;a"
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ORIGINAL
Valoración pronóstica de mortalidad y hospitalizaciones en pacientes ambulatorios con EPOC avanzada. Utilidad del índice CODEX
Prognostic assessment of mortality and hospitalizations of outpatients with advanced chronic obstructive pulmonary disease. Usefulness of the CODEX index
A. Navarroa, R. Costaa, M. Rodriguez-Carballeirab, S. Yunb, A. Lapuentea, A. Barrerab, E. Acostab, C. Viñasa, J.L. Herediaa, P. Almagrob,
Autor para correspondencia
19908pam@comb.cat

Autor para correspondencia.
a Servicio de Neumología, Hospital Universitario Mutua de Terrassa, Tarrasa, España
b Servicio de Medicina Interna, Hospital Universitario Mutua de Terrassa, Tarrasa, España

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