COPD phenotypes: differences in survival

Vázquez, Julio Hernández; García, Ismael Ali; Jiménez‐García, Rodrigo; Meca, Alejandro Álvaro; Andrés, Ana López de; Ruiz, Carmen Matesanz; García, María Jesús Buendía; Miguel-Díez, Javier de

doi:10.2147/copd.s166163

Cited by 15 publications

(14 citation statements)

References 35 publications

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“…In a recent study from Spain, the authors demonstrated that the Spanish ACO and NE phenotypes were associated with a more favourable outcome when compared to the two exacerbator phenotypes. 12 , 18 This is in full accordance with our results that showed similar patterns of mortality risk when using “Spanish” phenotypes as COPD classification. 12 , 18 , 19 Besides, our data showed similar mortality patterns also for the GOLD groups and stages.…”

Section: Discussionsupporting

confidence: 91%

The Relation Between Clinical Phenotypes, GOLD Groups/Stages and Mortality in COPD Patients – A Prospective Multicenter Study

Brat¹,

Svoboda²,

Zatloukal³

et al. 2021

COPD

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Introduction The concept of phenotyping emerged, reflecting specific clinical, pulmonary and extrapulmonary features of each particular chronic obstructive pulmonary disease (COPD) case. Our aim was to analyze prognostic utility of: “Czech“ COPD phenotypes and their most frequent combinations, ”Spanish” phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages + groups in relation to long-term mortality risk. Methods Data were extracted from the Czech Multicenter Research Database (CMRD) of COPD. Kaplan-Meier (KM) estimates (at 60 months from inclusion) were used for mortality assessment. Survival rates were calculated for the six elementary “Czech” phenotypes and their most frequent and relevant combinations, “Spanish” phenotypes, GOLD grades and groups. Statistically significant differences were tested by Log Rank test. An analysis of factors underlying mortality risk (the role of confounders) has been assessed with the use of classification and regression tree (CART) analysis. Basic factors showing significant differences between deceased and living patients were entered into the CART model. This showed six different risk groups, the differences in risk were tested by a Log Rank test. Results The cohort (n=720) was 73.1% men, with a mean age of 66.6 years and mean FEV 1 44.4% pred. KM estimates showed bronchiectases/COPD overlap (HR 1.425, p=0.045), frequent exacerbator (HR 1.58, p<0.001), cachexia (HR 2.262, p<0.001) and emphysematous (HR 1.786, p=0.015) phenotypes associated with higher mortality risk. Co-presence of multiple phenotypes in a single patient had additive effect on risk; combination of emphysema, cachexia and frequent exacerbations translated into poorest prognosis (HR 3.075; p<0.001). Of the “Spanish” phenotypes, AE CB and AE non-CB were associated with greater risk of mortality (HR 1.787 and 2.001; both p=0.001). FEV 1 % pred., cachexia and chronic heart failure in patient history were the major underlying factors determining mortality risk in our cohort. Conclusion Certain phenotypes (“Czech” or “Spanish”) of COPD are associated with higher risk of death. Co-presence of multiple phenotypes (emphysematous plus cachectic plus frequent exacerbator) in a single individual was associated with amplified risk of mortality.

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Section: Discussionsupporting

confidence: 91%

The Relation Between Clinical Phenotypes, GOLD Groups/Stages and Mortality in COPD Patients – A Prospective Multicenter Study

Brat¹,

Svoboda²,

Zatloukal³

et al. 2021

COPD

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“… 13 According to GesEPOC, a patient has asthma-COPD overlap (ACO) phenotype if they demonstrate a very positive response in the bronchodilator test, defined as an FEV1 increment greater than 400 mL in absolute value and 15% in relative value. Similar to other published studies, 15 we think that this definition provides very high specificity but little sensitivity for this phenotype. Instead of the ACO phenotype, we use the PRTB phenotype.…”

Section: Methodssupporting

confidence: 89%

“…The classification of COPD patients into different phenotypes is a recommendation that has been added to clinical practice guidelines in recent years, 13 , 14 since not all COPD patients clinically behave in the same way or present the same evolution. 15 Therefore, it is also interesting to investigate the influence of these comorbid conditions on each COPD phenotype.…”

Section: Introductionmentioning

confidence: 99%

<p>Influence of Comorbidities on the Survival of COPD Patients According to Phenotypes</p>

Hernández-Vázquez

Domínguez-Zabaleta

et al. 2020

COPD

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Background Chronic obstructive pulmonary disease (COPD) usually occurs alongside other conditions. Few studies on comorbidities have taken into account the phenotypes of COPD patients. The objective of this study is to evaluate the prevalence of comorbidities included in the Charlson index and their influence on the survival of patients with COPD, taking phenotypes into account. Methods An observational study was conducted on a group of 273 patients who had COPD and underwent spirometry in the first half of 2011, with a median prospective follow-up period of 68.15 months. The survival of these patients was analyzed according to the presence of various comorbidities. Results Of the 273 patients, 93 (34.1%) died within the follow-up period. An increased presence of chronic ischemic heart disease (CIHD), chronic heart failure (CHF), chronic kidney disease (CKD), and malignancy was found in deceased patients. All of these conditions shorten the survival of COPD patients globally; however, when considering phenotypes, only CHF influences the exacerbator with chronic bronchitis phenotype, CKD influences the non-exacerbator phenotype, and malignancy influences the positive bronchodilator test (BDT) and exacerbator with chronic bronchitis phenotypes. In the multivariate model, advanced age (hazard ratio, HR: 1.05; p =0.001), CHF (HR: 1.74; p =0.030), and the presence of malignancy (HR: 1.78; p =0.010) were observed as independent mortality risk factors. Conclusion The survival is shorter in the presence of CIHD in overall COPD patients and also CHF, CKD, and malignancy for certain phenotypes. It is important to pay attention to these comorbidities in the comprehensive care of COPD patients.

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“…The difference in mortality was demonstrated for different phenotypes, although it is striking that no statistically significant differences were found for the exacerbator-with-chronic-bronchitis phenotype, possibly because this phenotype is associated with poorer survival than the other phenotypes [8]. In fact, we found that the Kaplan-Meier survival curve of patients with pneumonia having this phenotype was much lower than that of the group of patients without pneumonia at 18 months presenting the other phenotypes.…”

Section: Discussionmentioning

confidence: 55%

“…Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease with elevated morbidity and mortality [6][7][8]. It is often accompanied by various comorbid conditions including arthritis, heart disease, arterial hypertension, diabetes mellitus, dyslipidemia, psychiatric disease, gastrointestinal disorders, cancer, and osteoporosis [9,10].…”

Section: Introductionmentioning

confidence: 99%

Influence of Pneumonia on the Survival of Patients with COPD

Vázquez

Cano

et al. 2020

JCM

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Background: Pneumonia is a frequent infection. Chronic obstructive pulmonary disease (COPD) can present with comorbidities, including pneumonia. It is known that COPD worsens the evolution of pneumonia, but few studies describe the impact of pneumonia on COPD evolution. This study analyzes the influence of pneumonia on the survival of COPD patients. Methods: Observational study of a cohort of 273 patients with COPD who attended spirometry in 2011, with a prospective follow-up of six years. Patients were divided into two groups according to their acquisition of pneumonia during follow-up. The difference in survival between the two groups was analyzed. Results: Survival was lower in the group with pneumonia compared with that without pneumonia (p = 0.000), both globally and after stratification by COPD phenotype. Pneumonia (Hazard Ratio -HR- 2.65; 95% Confidence Interval -CI- 1.57–4.48), advanced age (HR 1.08; 95% CI 1.03–1.09), and high Charlson index (HR 1.31; 95% CI 1.17–1.47) were identified as risk factors independently associated with mortality, while a high body mass index (HR 0.92; 95% CI 0.87–0.96) was identified as a protective factor. Conclusions: Pneumonia is associated with worse prognosis in COPD patients. It is important to take into account this comorbidity for a comprehensive care of these patients.

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COPD phenotypes: differences in survival

Cited by 15 publications

References 35 publications

The Relation Between Clinical Phenotypes, GOLD Groups/Stages and Mortality in COPD Patients – A Prospective Multicenter Study

The Relation Between Clinical Phenotypes, GOLD Groups/Stages and Mortality in COPD Patients – A Prospective Multicenter Study

<p>Influence of Comorbidities on the Survival of COPD Patients According to Phenotypes</p>

Influence of Pneumonia on the Survival of Patients with COPD

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