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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the letter published regarding our article entitled <span class="elsevierStyleItalic">The Importance of Dependence in the Global Assessment of Hospitalized Patients</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> We thank the authors for their comments on our research and agree with the main message of their letter&#44; as it serves to reinforce the importance of dependence in performing activities &#40;both basic and instrumental&#41; in the prediction of mortality in patients with chronic diseases&#46; We have observed that&#44; independently or in addition to the many other clinical&#44; demographic&#44; or functional variables usually included in the scores used in clinical practice&#44; variables related to dependence improve these scores and provide prognostic information&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to make a couple of comments on this communication&#46; First&#44; Briongos-Figuero et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> comment on our surprise that dependence for performing activities was an independent factor for mortality&#44; with a higher capacity for prediction than other clinical variables in patients admitted for COPD exacerbation&#46; However&#44; in the introduction to the article we said that what surprised us was the scant evidence available in this field in COPD&#44; unlike in other chronic diseases&#44; since the results of our study were far from a surprise&#46; In the SocioCOPD cohort itself&#44; on which we carried out the mortality study&#44; dependence for performing basic activities determined by non-specific COPD indices&#44; such as Barthel&#44; not only influences this event&#44; but is also one of the variables that best predicts short- and long-term readmissions for any cause after a severe exacerbation of COPD<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Indeed&#44; this is one of the alternative hypotheses of the initial research project&#46; What surprised us&#44; and still does&#44; is that so little emphasis is placed on this area in the clinical practice guidelines on COPD&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondly&#44; the authors refer to an interesting study that they published recently&#44; and point out the limited value of comorbidities &#40;determined by the Charlson index&#41; when adjusted for disability in the prediction of mortality&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> an outcome that differs from our findings&#46; In all the predictive models explored in the SocioCOPD cohort&#44; the number of comorbidities measured by this index did have a predictive capacity&#44; although the power was less than for dependence for both basic and instrumental activities&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; we would like to emphasize that these 2 studies are not at all comparable&#44; as the mean upper age of our correspondents&#8217; series was almost 20 years older than ours&#44; they had many more comorbidities&#44; and&#44; in particular&#44; less than 20&#37; of their patients were identified as having &#8220;chronic respiratory disease&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In a large COPD population<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> with a high comorbidity burden and age closer to that included in the study of Briongos-Figuero et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> reported by a working group of the Spanish Society of Internal Medicine&#44; the 2 factors that carried the greatest weight for predicting mortality were comorbidity and disability&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; we also believe that it is important to continue research in this line&#44; as it does not appear to be exclusive to elderly patients with multiple diseases&#44; but also affects to a large extent younger subjects with specific predominant diseases&#44; such as COPD in this case&#46;</p></span>"
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Letter to the Editor
Reply to “The Importance of Dependence in Global Assessment of Hospitalized Patient
Respuesta a La importancia de la dependencia en la valoración global del paciente hospitalizado
Sara Fernández-Garcíaa, Cristina Represas-Represasa, Alberto Ruano-Raviñab, Alberto Fernández Villara,
Corresponding author
a Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Spain
b Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Servicio de Medicina Preventiva, Hospital Clínico Universitario de Santiago de Compostela, CIBER de Epidemiología y Salud Pública (CIBERESP), Santiago de Compostela, Spain

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