Co-morbidities and Hyperinflation Are Independent Risk Factors of All-cause Mortality in Very Severe COPD. (1st August 2014)

• Record Type: Journal Article
• Authors: Budweiser, Stephan; Harlacher, Martina; Pfeifer, Michael; Jörres, Rudolf A.
• Is Part Of: COPD. Volume 11:Number 4(2014:Aug.)
• Page Start: 388
• Page End: 400
• Publication Date: 2014-08-01
• Subjects: Lungs -- Diseases, Obstructive -- Periodicals; 616.24
• DOI: 10.3109/15412555.2013.836174
• Languages: English
• ISSNs: 1541-2555

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Background:</italic> </bold> COPD is a multi-component disease that is not sufficiently reflected by FEV<sub>1</sub> alone. We studied in patients with very severe COPD, which dimensions of the disease, including co-morbidities, dominate prognosis. <bold><italic>Methods:</italic></bold> In patients with FEV<sub>1</sub> < 30% predicted, anthropometric, laboratory, spirometric and body plethysmographic data, smoking status, alcohol consumption, the level of dyspnoea and exercise performance were assessed. Co-morbidities were categorized by the Charlson-index and the COPD-specific co-morbidity test (COTE). The prognostic value of multiple dimensions was explored using uni- and multivariate survival analyses regarding death from any or respiratory cause. <bold><italic>Results:</italic></bold> Among 209 patients included (58/151 female/male; FEV<sub>1</sub> 25.0 (22.0–26.9)%predicted), arterial hypertension (54.1%), hyperlipidemia (38.3%) and diabetes (19.6%) were most common, 57.9% showing a COTE-index of ≥1 point. During follow-up (28 (14–45) months), 121 patients had died, mostly (56.2%) due to respiratory causes. Age, BMI, the ratio of residual volume to total lung capacity (RV/TLC), co-morbidities in terms of the COTE- and Charlson-index, but not FEV<sub>1</sub>, were significantly associated with all-cause and respiratory mortality. The association of the median values of the Charlson- (HR 1.911 [95%-CI 1.338–2.730]) and COTE-index (HR 1.852 [95%-CI 1.297–2.644], <italic>p</italic> < 0.001 each) with mortality was similar and stronger when combined with age. In multivariate analyses, only RV/TLC and co-morbidities were independent risk factors of all-cause mortality (<italic>p</italic> < 0.05 each). <bold><italic>Conclusion:</italic></bold> In very severe COPD, resting hyperinflation and co-morbidities provide the major prognostic information, whereas the association of the recently introduced COTE-index with mortality was similar to that of the established Charlson-index and even stronger when including age.</p> </abstract>