Should comorbidities be introduced in the Rome proposal for classification of ECOPD?

<bold>Background:</bold> The Rome Proposal aimed to classify of COPD exacerbation (ECOPD) severity based on quantitative variables. Several real-life studies validated the prognostic value of this classification. Although the importance of concomitant comorbid conditions in ECOPD is highlighted in the Rome proposal, no item is included to assess their relevance. <bold>Objectives:</bold> In this study we redefine the Rome Proposal by integrating the original scoring system with an item accounting for comorbidities, i.e. the Charlson Comorbidity Index (CCI). <bold>Methods:</bold> We retrospectively enrolled 533 patients hospitalized for ECOPD in our centre, and assessed the severity according to the Rome proposal. Based on literature review we modified the original scoring system by stepping up 1 degree of severity in patients with a CCI ≥ 6 and by decreasing one step of severity when the CCI was ≤4. <bold>Results:</bold> As compared to the original Rome classification, the addition of a to comorbidity component increased the prognostic association between the severity rank and the mortality rate both at 6 months and 12 months post-hospitalization (6%; 20%; 37 and 14%;27%; 48%, in mild, moderate and severe ECOPD at 6 months and 12 months respectively p<0.0001). In-hospital mortality followed the same trend, with increased mortality with severity (1,25%, 6,7%, 11,7% in mild, moderate and severe ECOPD respectively, p=0.02). <bold>Conclusion:</bold> Multimorbidity is a key feature of all COPD patients. Our results indicated that comorbidities should be integrated in ECOPD severity assessment.