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. 2025 Jun 11:20:1893-1913.
doi: 10.2147/COPD.S518218. eCollection 2025.

COTE and Pulmonary Comorbidities Predict Moderate-to-Severe Acute Exacerbation and Hospitalization in COPD

Qinglin Chen #  1 , Xinmao Wang #  1 , Xiujuan Yao  1 , Luo Zhang  2   3   4 , Xiaofang Liu  1
Affiliations

COTE and Pulmonary Comorbidities Predict Moderate-to-Severe Acute Exacerbation and Hospitalization in COPD

Qinglin Chen et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: The aim of this study was to explore the predictive value of the chronic obstructive pulmonary disease (COPD) specific comorbidity test index (COTE) and pulmonary comorbidities for moderate-to-severe acute exacerbation and hospitalization in COPD patients.

Patients and methods: This was a retrospective cohort study. We included 470 patients with stable COPD. Patients were divided into high or low-risk comorbidity group according to whether COTE score ≥4, and pulmonary comorbidities and extrapulmonary comorbidities group according to comorbidity origin. Moderate-to-severe acute exacerbation events and other clinical parameters were compared between groups. Multifactorial analysis and Lasso regression were used to screen risk factors and establish predictive models for moderate-to-severe acute exacerbation and hospitalization. The receiver operating characteristic (ROC) curve was used to assess the value COTE score and pulmonary comorbidities in predicting moderate-to-severe acute exacerbation and hospitalization.

Results: When compared with the low-risk comorbidity and extrapulmonary comorbidities group, the rate of patients with ≥2 moderate-to-severe acute exacerbations and requiring hospitalization due to acute exacerbations is higher in high-risk comorbidity and pulmonary comorbidities group (χ²=18.45, χ²=40.15, χ²=8.82, χ²=23.68). Multifactorial analysis showed that comorbid with asthma, lung cancer were risk factors for moderate-to-severe acute exacerbations, while asthma, bronchiectasis, lung cancer, and high COTE score were risk factors for patients requiring hospitalization due to acute exacerbations. The AUC for COTE > 5.5 and a combination of at least one pulmonary comorbidity as potential indication of moderate-to-severe acute exacerbations of COPD and hospitalization due to acute exacerbations was 0.667 (95% CI: 0.615, 0.719) and 0.740 (95% CI: 0.688, 0.792), respectively. The prediction models including COTE and pulmonary comorbidities can predict moderate-to-severe acute exacerbations (internal validation of AUC: 0.984, 95CI%: 0.964-1) and hospitalization (internal validation of AUC: 0.978, 95CI%: 0.959-0.998) of COPD.

Conclusion: COTE score and a combination of at least one pulmonary disease can predict the risk of moderate-to-severe acute exacerbations and hospitalization due to acute exacerbations in patients with COPD.

Keywords: acute exacerbation; chronic obstructive; comorbidity; hospitalization; pulmonary disease.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow of participants through the study.
Figure 2
Figure 2
Correlation heatmap of COTE.
Figure 3
Figure 3
Logistic analysis of moderate-to-severe acute exacerbation and hospitalization of COPD.
Figure 4
Figure 4
ROC curve of moderate-to-severe acute exacerbation and hospitalization of COPD.
Figure 5
Figure 5
Prediction model of ROC curve of moderate-to-severe acute exacerbation in COPD.
Figure 6
Figure 6
Prediction model of ROC curve of hospitalization in COPD.
Figure 7
Figure 7
Nomogram to predict the risk of moderate-to-severe acute exacerbation in COPD. Lung_cancer/asthma (1: with; 2: without).
Figure 8
Figure 8
Nomogram to predict the risk of hospitalization in COPD. Lung_cancer/asthma/bronchiectasis (1: with; 2: without).
Figure 9
Figure 9
Impact of age subgroup to COTE and the number of pulmorbidome in moderate-to-severe acute exacerbation and hospitalization of COPD.
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