<p>COPD classification models and mortality prediction capacity</p>

Abstract

ObjectiveOur aim was to assess the impact of comorbidities on existing COPD prognosis scores.Patients and methodsA total of 543 patients with COPD (FEV1 <80% and FEV1/FVC <70%) were included between January 2003 and January 2004. Patients were stable for at least 6 weeks before inclusion and were followed for 5 years without any intervention by the research team. Comorbidities and causes of death were established from medical reports or information from primary care medical records. The GOLD system and the body mass index, obstruction, dyspnea and exercise (BODE) index were used for COPD classification. Patients were also classified into four clusters depending on the respiratory disease and comorbidities. Cluster analysis was performed by combining multiple correspondence analyses and automatic classification. Receiver operating characteristic curves and the area under the curve (AUC) were calculated for each model, and the DeLong test was used to evaluate differences between AUCs. Improvement in prediction ability was analyzed by the DeLong test, category-free net reclassification improvement and the integrated discrimination index.ResultsAmong the 543 patients enrolled, 521 (96%) were male, with a mean age of 68 years, mean body mass index 28.3 and mean FEV1% 55%. A total of 167 patients died during the study follow-up. Comorbidities were prevalent in our cohort, with a mean Charlson index of 2.4. The most prevalent comorbidities were hypertension, diabetes mellitus and cardiovascular diseases. On comparing the BODE index, GOLDABCD, GOLD2017 and cluster analysis for predicting mortality, cluster system was found to be superior compared with GOLD2017 (0.654 vs 0.722, P=0.006), without significant differences between other classification models. When cardiovascular comorbidities and chronic renal failure were added to the existing scores, their prognostic capacity was statistically superior (P<0.001).ConclusionComorbidities should be taken into account in COPD management scores due to their prevalence and impact on mortality.

Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2015 and GOLD 2019 staging: a pooled analysis of individual patient data

“…All these classifications were initially designed not to assess prognosis, but to aid clinicians in creating optimal treatment regimens for patients. Thus, the prognostic ability of GOLD 2019 compared to previous classifications is largely unknown, with only a few published studies [ 11 , 12 ]. To address this issue, we used pooled data from 17 139 patients of 22 COPD cohorts and 11 countries and compared the prognostic capacity of the 2019 versus 2015 GOLD staging classifications to predict mortality.…”

Predictive factors over time of health-related quality of life in COPD patients

“…In our opinion, it is probably a matter of people's expectations changing as they get older and/or they progressively get used to living with the disease. It might be expected that cardiovascular comorbidities would play an important role in HRQoL of COPD patients [39], but this does not seem to be observed, unlike for other comorbidities, such as depression, which have been shown to contribute strongly to HRQoL [40]. In a European cross-sectional study, a cut-off of three comorbidities established significant differences in HRQoL, and though COPD patients with cardiovascular comorbidities had worse scores in HRQoL (SGRQ), the minimal clinically important difference was not reached [41].…”

Pattern of comorbidities and 1-year mortality in elderly patients with COPD hospitalized in internal medicine wards: data from the RePoSI Registry

“…Although comorbidities are increasingly identified as important factors of COPD management and outcomes [ 15 ], studies specifically designed to evaluate the relationships between comorbidities and long-term outcomes in subjects with a diagnosis of COPD admitted to an internal medicine ward are scarce [ 16 ], and this is also true for several chronic diseases [ 17 ]. A recent study showed that the addition of comorbidities to age, BMI, blood markers and indexes such as smoking status, dyspnea assessment, airway obstruction produced a model, known as BARC index, that performed better than established index scores in predicting 1-year mortality [ 18 ].…”