One-year change in health status and subsequent outcomes in COPD. Issue 5 (17th March 2015)

• Record Type: Journal Article
• Authors: Wilke, Sarah; Jones, Paul W; Müllerova, H; Vestbo, Jørgen; Tal-Singer, Ruth; Franssen, Frits ME; Agusti, Alvar; Bakke, Per; Calverley, Peter M; Coxson, Harvey O; Crim, Courtney; Edwards, Lisa D; Lomas, David A; MacNee, William; Rennard, Stephen I; Yates, Julie C; Wouters, Emiel FM; Spruit, Martijn A
• Is Part Of: Thorax. Volume 70:Issue 5(2015)
• Page Start: 420
• Page End: 425
• Publication Date: 2015-03-17
• Subjects: COPD Exacerbations; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2014-205697
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Poor health status has been associated with morbidity and mortality in patients with COPD. To date, the impact of changes in health status on these outcomes remains unknown. Aims: To explore the relationship of clinically relevant changes in health status with exacerbation, hospitalisation or death in patients with COPD. Methods: Characteristics and health status (St George's Respiratory Questionnaire, SGRQ) were assessed over a period of 3 years in 2138 patients with COPD enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study: a longitudinal, prospective, observational study. Associations between change in health status (=4 units in SGRQ score) during year 1 and time to first exacerbation, hospitalisation and death during 2-year follow-up were assessed using Kaplan–Meier plots and log-rank test. Results: 1832 (85.7%) patients (age 63.4±7.0 years, 65.4% male, FEV1 48.7±15.6% predicted) underwent assessment at baseline and 1 year. Compared with those who deteriorated, patients with improved or stable health status in year 1 have a lower likelihood of exacerbation (HR 0.78 (95% CI 0.67 to 0.89), p<0.001 and 0.84 (0.73 to 0.97), p=0.016, respectively), hospitalisation (0.72 (0.58 to 0.90), p=0.004 and 0.77 (0.62 to 0.96), p=0.023, respectively) or dying (0.61 (0.39 to 0.95), p=0.027 and 0.58 (0.37 to 0.92), p=0.019, respectively) during 2-year follow-up. This effect persisted after stratification for age and the number of exacerbations and hospitalisations during the first year of the study. Conclusions: Patients with stable or improved health status during year 1 of ECLIPSE had a lower likelihood of exacerbation, hospitalisation or dying during 2-year follow-up. Interventions that stabilise and improve health status may also improve outcomes in patients with COPD. Trial registration number: NCT00292552, registered at ClinicalTrials.gov.