Cardiovascular comorbidities in hospitalised COPD patients: a determinant of future risk?

Abstract

Cardiovascular disease (CVD), diabetes mellitus and arterial hypertension increase the risk of death and hospitalisations of chronic obstructive pulmonary disease (COPD) patients [1]. COPD patients with CVD are at increased risk of COPD-related hospitalisations [2]. Arterial hypertension is one of the most prevalent comorbidities, influencing 40-60% of COPD patients [1]. Diabetes mellitus is more prevalent in moderate to very severe COPD than in the general population [1] and hyperglycaemia during acute exacerbations of COPD (AECOPD) is associated with increased in-hospital mortality [3]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has proposed a multidimensional classification for COPD management [4,5] that includes symptoms and future risk of AECOPD, based on the severity of airflow limitation and previous exacerbation history. A recent study has shown that the risk of future hospital admission due to COPD and cardiovascular death is higher in the more symptomatic group B compared with group C, regardless the functional advantage of patients in the first group [6]. Our study assessed the effect of CVD, arterial hypertension and diabetes mellitus on the time to first AECOPD, and on exacerbation and hospitalisation risk in groups A-D of the GOLD 2011 and 2013 classification, in a cohort of patients admitted to hospital for AECOPD.We prospectively enrolled 609 consecutive patients admitted to respiratory medicine departments of two tertiary hospitals with a diagnosis of AECOPD between March 2009 and February 2013. All subjects were current or ex-smokers with ⩾20 pack-years and a previous spirometry-confirmed diagnosis of COPD. Patients with other comorbid respiratory conditions, comorbidities that might result in a limited expected survival (such as malignancies, leukaemia or AIDS) or with an inability to cooperate with the investigators were excluded. The study protocol was approved by the ethics committees of both hospitals and participants provided informed consent. Symptoms were evaluated according to the COPD assessment test (CAT) [7] and the modified Medical Research Council (mMRC) dyspnoea scale [8]. Spirometry data were from patients' medical records when their COPD was stable (during the last 6 months and ⩾4 weeks before admission). Patients were categorised into the GOLD 2011 groups, as follows. Group A: fewer symptoms (mMRC <2/CAT <10), forced expiratory volume in 1 s (FEV1) >50% predicted and fewer than two exacerbations in the previous year. Group B: more symptoms (mMRC ⩾2/CAT ⩾10), FEV1 >50% predicted and fewer than two exacerbations in the previous year. Group C: fewer symptoms (mMRC <2/ CAT <10), FEV1 ⩽50% predicted and/or two or more exacerbations in the previous year. Group D: more symptoms (mMRC ⩾2/CAT ⩾10), FEV1 ⩽50% predicted and/or two or more exacerbations in the previous year [4]. In cases of discrepancy between the CAT and mMRC scales, the patient was categorised in the higher category (B or D). We performed an additional analysis classifying all our hospitalised pat...

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