Sex-specific associations of comorbidome and pulmorbidome with mortality in chronic obstructive pulmonary disease: results from COSYCONET

Abstract

In patients with COPD, it has not been comprehensively assessed whether the predictive value of comorbidities for mortality differs between men and women. We therefore aimed to examine sex differences of COPD comorbidities in regard with prognosis by classifying comorbidities into a comorbidome related to extrapulmonary disorders and a pulmorbidome, referring to pulmonary disorders. The study population comprised 1044 women and 1531 men with the diagnosis of COPD from COSYCONET, among them 2175 of GOLD grades 1–4 and 400 at risk. Associations of comorbidities with mortality were studied using Cox regression analysis for men and women separately. During the follow-up (median 3.7 years) 59 women and 159 men died. In men, obesity, hypertension, coronary artery disease, liver cirrhosis, osteoporosis, kidney disease, anaemia and increased heart rate (HR) predict mortality, in women heart failure, hyperuricemia, mental disorders, kidney disease and increased HR (p < 0.05 each). Regarding the pulmorbidome, significant predictors in men were impairment in diffusion capacity and hyperinflation, in women asthma and hyperinflation. Similar results were obtained when repeating the analyses in GOLD 1–4 patients only. Gender differences should be considered in COPD risk assessment for a tailored approach towards the treatment of COPD.Clinical Trial Registration: ClinicalTrials.gov NCT01245933.

Cardiovascular predictors of mortality and exacerbations in patients with COPD

“…In contrast, average annual exacerbation rate was associated with the annual decline of FEV 1 but not that of CO diffusing capacity, and with none of the cardiovascular comorbidities. Thus, parameters of lung function contributed differently to the prediction of mortality and exacerbation rate, potentially in relation to different COPD and comorbidity phenotypes and consistent with previous data 27 – 29 . Covering a broad spectrum of predictors including cardiovascular medication, the detailed comparison of associations with mortality and exacerbation rate specifically revealed the different role of comorbidities and functional parameters.…”

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

“…Moreover, the knowledge of the possible physio-pathological interactions among comorbidities can contribute to the improvement of prevention and treatment strategies. As highlighted in different studies, the comorbidome is an effective tool to represent the comorbidities related to an increased mortality in COPD [ 12 ], the associations between sex specific comorbidities, and the mortality in COPD subjects [ 13 ], as well as comorbidities associated with higher risk of acute heart failure [ 14 ].…”

“…The importance of this graphic representation lies in the fact that it is possible to identify the most relevant and statistically important comorbidity. Recent studies have used comorbidome to represent associations between sex-specific comorbidities and mortality in COPD subjects [ 13 ], as well as comorbidities associated with higher risk of acute heart failure [ 14 ] Moreover, other approaches, such as a comorbidity network, have been used to develop a diabetes-risk prediction model [ 15 ]…”

Was haben wir aus der deutschen COPD-Kohorte COSYCONET gelernt und wie geht es weiter?

“…Auch in Hinsicht auf das Bestehen einer kardialen Komorbidität waren ausgewählte Fragen des CAT informativer als der Gesamtscore, v. a. dann, wenn Unterschiede zwischen Männern und Frauen in Betracht gezogen wurden [25]. Dass selbst solche Komorbiditäten, die sowohl bei Männern als auch bei Frauen vorkommen, einen zwischen den Geschlechtern verschiedenen Stellenwert für die Mortalität haben können, ließ sich in einer zusammenfassenden Analyse des Komorbidoms und Pulmorbidoms eindringlich zeigen [24]. Bemerkenswerterweise bestand der unterschiedliche prädiktive Wert einzelner Komorbiditäten für die Mortalität unabhängig von der teils unterschiedlichen Prävalenz bei Männern und Frauen (▶ Abb.…”

“…Zum anderen stellt sich die Frage, ob eine Chance besteht, anhand der Symptome einer COPD, v. a. der Belastungssymptome, auf das Vorliegen einer Herzerkrankung zu schließen, obwohl diese Symptome von der Lungenerkrankung dominiert werden [23]. COSYCONET-Daten ergaben, dass 30 dass die Beziehung einer kardialen Erkrankung zu Symptomen und Lungenfunktion für Männer und Frauen unterschiedlich war [24,25].…”