Prediction of severe exacerbations and mortality in COPD: the role of exacerbation history and inspiratory capacity/total lung capacity ratio

Abstract

BackgroundSevere exacerbations and mortality are major outcomes in COPD, and risk factors for these events are actively searched for. Several predictors of mortality have been identified in COPD. The inspiratory capacity/total lung capacity (IC/TLC) ratio has been shown to be a strong predictor of all cause and respiratory mortality in patients with COPD. The major objectives of this study were to analyze which clinical parameters, including lung volumes, were the best predictors of the 5-year cumulative risk of hospital admissions or death and the 5-year risk of exacerbations, in stable COPD patients.MethodsThis study retrospectively reviewed data from 98 stable COPD patients, consecutively recruited in 2012. Forced expiratory volume in 1 s (FEV1), modified Medical Research Council dyspnea scale, exacerbation history (ExH), Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 groups, and lung volumes were reviewed. Five years later, this population was evaluated for cumulative exacerbations, hospital admissions, and mortality. All the population, and GOLD group D separately, were analyzed.ResultsThe cumulative 5-year combined risk of hospital admission or death was significantly predicted by the ExH and the IC/TLC ratio. Analyzing separately group D, FEV1 was the only predictor of this outcome. The frequency of exacerbations in the previous year was the best predictor of future cumulative 5-year risk of subsequent exacerbations, both for the total population and the GOLD D group.ConclusionExH and IC/TLC ratio were the best predictors of the most severe outcomes in COPD (admissions or mortality), independently of COPD severity. FEV1 was the only predictor of the cumulative 5-year combined risk of hospital admission or death in the GOLD D group. ExH was the best predictor of 5-year cumulative future risk of exacerbations. Besides FEV1 and ExH, the IC/TLC ratio can be a useful predictor of severe outcomes in COPD.

Chronic obstructive pulmonary disease and related phenotypes: polygenic risk scores in population-based and case-control cohorts

“…To our knowledge, this is the first report of a statistically significant association between a genetic risk score and COPD exacerbations. This association suggests a shared mechanism between lung function and COPD exacerbations, consistent both with published reports that low lung function is a risk factor for exacerbations, 57 , 58 and with this association no longer being observed after adjustment for lung function. The latter observation indicates that the polygenic risk score is unlikely to add utility to the prediction of exacerbations when baseline lung function is already available and incorporated in the prediction model.…”

Protocol for an observational study to identify potential predictors of an acute exacerbation in patients with chronic obstructive pulmonary disease (the PACE Study)

“…Until now, research in the field of AECOPD has gathered and analysed data usually after manifestation of AECOPD until recovery and most of them used a retrospective study design. 16 17 A recent systematic review on the monitoring of physiological parameters (eg, oxygen saturation, heart rate or respiratory rate) to predict an AECOPD concluded that there is currently insufficient information on how physiological parameters vary prior to exacerbation to support routine domiciliary monitoring for the prediction of AECOPD. 18 It would be of extreme clinical importance to determine early predictors of an AECOPD and to identify patients who are at high risk for developing an acute exacerbation and/or to detect the beginning of or prevent an acute exacerbation as early as possible.…”

Risk factors of chronic obstructive pulmonary disease exacerbations

“…According to both older and newer published research, the most consistent predictor of COPD exacerbations is a previous history of exacerbations …”

“…According to both older and newer published research, the most consistent predictor of COPD exacerbations is a previous history of exacerbations. 37,[58][59][60][61][62] A recent Portuguese study 59 analysing the 5-year prediction of the combination of exacerbations, hospital admissions and mortality in stable COPD patients, previous year exacerbation represented the best predictor of the future risk of exacerbations, independent of severity. During the 5-year follow-up, almost 70% of GOLD C patients and almost 90% of GOLD D patients suffered exacerbations.…”