Predictors of mortality in patients with COPD after 9 years

Abstract

BackgroundCOPD is one of the leading causes of morbidity and mortality in the world; however, the most varied amounts of clinical and laboratory characteristics acts in different ways in the mortality among over time. Therefore, this study aimed to evaluate the predictors of mortality in patients with COPD after 9 years.Patients and methodsOne hundred and thirty-three patients with COPD were assessed at baseline by spirometry, pulse oximetry (SpO2), body composition, intensity of dyspnea, distance walked in the 6-minute walk test (6MWT), and Charlson Comorbidity Index (CCI).ResultsAfter 9 years, it was not possible to identify the lifetime of 4 patients who died and of 19 patients who stopped follow-up; thus, 110 patients were included in the analysis of predictors of mortality (67% male, 65±9 years old, and FEV1: 52.5 [40%–73%]). Male sex, age, SpO2, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, and frequency of exacerbations in the first 3 years of follow-up were considered in the model. Patients classified at baseline with BODE class 2 (HR: 2.62, 95% CI: 1.36–5.04; P=0.004), BODE class 3 (HR: 2.54, 95% CI: 1.15–5.61; P=0.02), and BODE class 4 (HR: 15.35, 95% CI: 3.11–75.75; P=0.001) showed increased risk of death compared to those with BODE class 1. The CCI (HR: 1.29, 95% CI: 1.00–1.68; P=0.04) and the number of exacerbations in the first 3 years (HR: 1.32, 95% CI: 1.00–1.76; P=0.04) also showed increased risk of death. By replacing the BODE index for the variables that compose it, those with body mass index ≤21 kg/m2 showed increased risk of death compared to those with body mass index (BMI)>21 kg/m2 (HR: 2.70, 95% CI: 1.38–5.25; P=0.003).ConclusionAfter 9 years, we identified that those with high BODE index, greater CCI, greater frequency of exacerbations in the first 3 years, and BMI ≤21 kg/m2 showed increased risk of death.

<p>Early Predictors of Mortality in Patients with COPD, in Relation to Respiratory and Non-Respiratory Causes of Death – A National Register Study</p>

“…[23][24][25] Moreover, comorbidities including, eg, heart failure, low BMI, and depression have all been associated with an increased risk of dying from COPD. [26][27][28][29] In order to obtain a higher precision, composites such as the BODE and ADO have been created, with proved predictive value in certain studies. 2,7,8,14,15,17,27 Many of the commonly suggested variables covary within the same patient.…”

“…[26][27][28][29] In order to obtain a higher precision, composites such as the BODE and ADO have been created, with proved predictive value in certain studies. 2,7,8,14,15,17,27 Many of the commonly suggested variables covary within the same patient. A person with severe COPD is likely to present with dyspnoea, as well as insufficient saturation, low FEV 1 %, and episodes of exacerbations, and so on.…”

“…Demographic variables from the SRTR comprise age and gender. Patient-related variables concern airway obstruction, measured by FEV 1% after bronchodilation if available, otherwise without bronchodilation, as well as oxygen saturation, number of exacerbations, and number of hospital admissions due to COPD in the last 12 months, BMI, which was categorized as <22, [22][23][24][25][26][27][28][29][30], and >30 kg/m 2 , and comorbidity. Patient-reported variables comprised smoking, exercise activity, measured by reported number of days with physical activity per week, and functional dyspnea, measured using the modified Medical Research Council (mMRC) Dyspnea Scale.…”

<p>FEV₁ is a stronger mortality predictor than FVC in patients with moderate COPD and with an increased risk for cardiovascular disease</p>

“…1 Clinical variables that predict mortality are important for identifying patients at highest risk and include lung function, exacerbation burden and comorbidities. [1][2][3][4] Interestingly, when comparing mortality risk based purely on lung function and the symptoms-exacerbation risk-based Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 COPD classification, lung function served as a better predictor. 5 It has long been debated whether forced expiratory volume in one second (FEV 1 ) or forced vital capacity (FVC) is the best physiological prognostic measure and if the relationship between FEV 1 and mortality is due to airflow limitation or low lung volumes.…”

Elevated blood eosinophils in acute COPD exacerbations: better short- and long-term prognosis

“…Previous studies have reported a wide range of mortality which depends on follow-up period, for example, 16% for 90-day mortality [37], 19-26% for 1-year mortality [32,38] to 64% for 5-year mortality [38]. Due to the retrospective nature of our study, we were not able to use any indices such as BODE (Body mass index, airway Obstruction, Dyspnea, and Exercise capacity) or CCI (Charlson Comorbidity Index) to predict the mortality in COPD patients, as did other [39]. Our pre-admission data (Table 1) shows that around 50% of the patients in both groups were still smokers.…”