Long-term Prognosis in COPD Exacerbation: Role of Biomarkers, Clinical Variables and Exacerbation Type. (4th May 2015)

• Record Type: Journal Article
• Authors: Grolimund, Eva; Kutz, Alexander; Marlowe, Robert J.; Vögeli, Alaadin; Alan, Murat; Christ-Crain, Mirjam; Thomann, Robert; Falconnier, Claudine; Hoess, Claus; Henzen, Christoph; Zimmerli, Werner; Mueller, Beat; Schuetz, Philipp
• Is Part Of: COPD. Volume 12:Number 3(2015:Jun.)
• Page Start: 300
• Page End: 310
• Publication Date: 2015-05-04
• Subjects: accuracy -- blood biomarkers -- chronic obstructive pulmonary disease (COPD) -- long-term all-cause mortality -- mortality prediction -- proadrenomedullin (ProADM) -- multidimensional risk stratification -- non-pneumonic exacerbation -- pneumonic exacerbation; Lungs -- Diseases, Obstructive -- Periodicals; 616.24
• DOI: 10.3109/15412555.2014.949002
• Languages: English
• ISSNs: 1541-2555

Abstract

Abstract: Long-term outcome prediction in COPD is challenging. We conducted a prospective 5–7-year follow-up study in patients with COPD to determine the association of exacerbation type, discharge levels of inflammatory biomarkers including procalctionin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and plasma proadrenomedullin (ProADM), alone or combined with demographic/clinical characteristics, with long-term all-cause mortality in the COPD setting. The analyzed cohort comprised 469 patients with index hospitalization for pneumonic (n = 252) or non-pneumonic (n = 217) COPD exacerbation. Five-to-seven-year vital status was ascertained via structured phone interviews with patients or their household members/primary care physicians. We investigated predictive accuracy using univariate and multivariate Cox regression models and area under the receiver operating characteristic curve (AUC). After a median [25th–75th percentile] 6.1 [5.6–6.5] years, mortality was 55% (95%CI 50%–59%). Discharge ProADM concentration was strongly associated with 5–7-year non-survival: adjusted hazard ratio (HR)/10-fold increase (95%CI) 10.4 (6.2–17.7). Weaker associations were found for PCT and no significant associations were found for CRP or WBC. Combining ProADM with demographic/clinical variables including age, smoking status, BMI, New York Heart Association dyspnea class, exacerbation type, and comorbidities significantly improved long-term predictive accuracy over that of the demographic/clinical model alone: AUC (95%CI) 0.745 (0.701–0.789) versus 0.727 (0.681–0.772), p = .043. In patients hospitalized for COPD exacerbation, discharge ProADM levels appeared to accurately predict 5–7-year all-cause mortality and to improve long-term prognostic accuracy of multidimensional demographic/clinical mortality risk assessment.