Prediction models for exacerbations in different COPD patient populations: comparing results of five large data sources

Hoogendoorn, Martine; Feenstra, Talitha; Boland, Melinde; Briggs, Andrew; Borg, Sixten; Jansson, Sven-Arne; Risebrough, Nancy; Slejko, Julia F.; Mölken, Maureen P.M.H. Pmhrutten-van

doi:10.2147/copd.s142378

Cited by 39 publications

(41 citation statements)

References 35 publications

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“…Confirming previous findings, lower FEV 1 and FEV 1 /FVC were associated with higher risk for COPD exacerbations. 13,25,26 Increased disease severity is associated with heightened airway and systemic inflammation. 27 The ECLIPSE study highlighted the potential role of persistent systemic inflammation leading to frequent exacerbations.…”

Section: Discussionmentioning

confidence: 99%

“…11 However, it is debated if established CVD is an independent risk factor for COPD exacerbations. 12,13 Regarding cardiovascular mortality, a strong association has been found with FVC, 14 FEV 1 , [15][16][17] and the rate of lung function decline 18 in population-based studies, suggesting that cardiovascular morbidity may be a relevant factor when investigating the relationship between lung function and mortality. Finally, COPD exacerbations pose an increased risk for cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

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FEV1 is a stronger mortality predictor than FVC in patients with moderate COPD and with an increased risk for cardiovascular disease

Bikov¹,

Lange²,

Anderson³

et al. 2020

COPD

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Purpose: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Impaired lung function is associated with heightened risk for death, cardiovascular events, and COPD exacerbations. However, it is unclear if forced expiratory volume in one second (FEV 1) and forced vital capacity (FVC) differ in predictive value. Patients and Methods: Data from 16,485 participants in the Study to Understand Mortality and Morbidity (SUMMIT) in COPD were analyzed. Patients were grouped into quintiles for each lung function parameter (FEV 1 %predicted, FVC %predicted, FEV 1 /FVC). The four highest quintiles (Q2-Q5) were compared to the lowest (Q1) to assess their relationship with all-cause mortality, cardiovascular events, and moderate-to-severe and severe exacerbations. Cox-regression was used, adjusted for age, sex, ethnicity, body-mass index, smoking status, previous exacerbations, cardiovascular disease, treatment, and modified Medical Research Council dyspnea score. Results: Compared to Q1 (<53.5% FEV 1 predicted), increasing FEV 1 quintiles (Q2 53.5-457.5% predicted, Q3 57.5-461.6% predicted, Q4 61.6-465.8% predicted, and Q5 ≥65.8%) were all associated with significantly decreased all-cause mortality (20% (4-34%), 28% (13-40%), 23% (7-36%), and 30% (15-42%) risk reduction, respectively). In contrast, a significant risk reduction (21% (4-35%)) was seen only between Q1 and Q5 quintiles of FVC. Neither FEV 1 nor FVC was associated with cardiovascular risk. Increased FEV 1 and FEV 1 /FVC quintiles were also associated with the reduction of moderate-to-severe and severe exacerbations while, surprisingly, the highest FVC quintile was related to the heightened exacerbation risk (28% (8-52%) risk increase). Conclusion: Our results suggest that FEV 1 is a stronger predictor for all-cause mortality than FVC in moderate COPD patients with heightened cardiovascular risk and that subjects with moderate COPD have very different risks.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

FEV1 is a stronger mortality predictor than FVC in patients with moderate COPD and with an increased risk for cardiovascular disease

Bikov¹,

Lange²,

Anderson³

et al. 2020

COPD

View full text Add to dashboard Cite

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“…The prevalence of COPD exacerbations is high, with over 50% of patients with COPD experiencing exacerbations in multiple long-term studies that lasted 3 years or more [5]. Furthermore, patients can experience multiple COPD exacerbations per year: 23% of patients with a spirometryconfirmed diagnosis of COPD experienced ≥2 moderate/severe exacerbations per year, and 14% of patients experienced ≥3 exacerbations per year [6,7].…”

Section: Introductionmentioning

confidence: 99%

Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life

Hurst

Skolnik

Hansen

et al. 2020

European Journal of Internal Medicine

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Exacerbations of chronic obstructive pulmonary disease (COPD) represent a significant clinical problem, and are associated with decreased lung function, worsening quality of life and decreased physical activity levels, with even a single exacerbation having detrimental effects. The occurrence of COPD exacerbations can also have a considerable impact on healthcare costs and mortality rates, with over one-fifth of patients hospitalized for a COPD exacerbation for the first time dying within one year of discharge. This highlights the need for COPD exacerbations to be a major focus in clinical practice. Furthermore, the substantial effect that COPD exacerbations can have on patient mental health should not be underestimated. Despite their clinical importance, COPD exacerbations are poorly recognized and reported by patients, and improving patient understanding and reporting of exacerbations to ensure prompt treatment may minimize their deleterious effects. Renewed focus on improving current clinical practice with support from evidence-based guidelines is required. This also raises a challenge to payors, healthcare systems and government policies to do more to tackle the considerable outstanding burden of COPD exacerbations. Search methodsRelevant articles for this non-systematic, narrative literature review were identified via PubMed searches and from author knowledge. Only articles published in English were included.

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“…A significant percentage of patients will be re-hospitalized during the first month after their initial discharge [6,10]. Hospital readmission for eCOPD is a major problem, since it reinforces the burden of the disease [11,12]. Hospitalization due to eCOPD is not only related to an increased risk for hospital readmission and mortality, but it is also associated with an increased risk for cardiovascular events [13].…”

Section: Introductionmentioning

confidence: 99%

Physical, Psychological, and Social Factors Associated with Exacerbation-Related Hospitalization in Patients with COPD

Crutsen

Keene

Janssen

et al. 2020

JCM

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Background and objective: Exacerbation(s) of chronic obstructive pulmonary disease (eCOPD) entail important events describing an acute deterioration of respiratory symptoms. Changes in medication and/or hospitalization are needed to gain control over the event. However, an exacerbation leading to hospitalization is associated with a worse prognosis for the patient. The objective of this study is to explore factors that could predict the probability of an eCOPD-related hospitalization. Methods: Data from 128 patients with COPD included in a prospective, longitudinal study were used. At baseline, physical, emotional, and social status of the patients were assessed. Moreover, hospital admission during a one year follow-up was captured. Different models were made based on univariate analysis, literature, and practice. These models were combined to come to one final overall prediction model. Results: During follow-up, 31 (24.2%) participants were admitted for eCOPD. The overall model contained six significant variables: currently smoking (OR = 3.93), forced vital capacity (FVC; OR = 0.97), timed-up-and-go time (TUG-time) (OR = 14.16), knowledge (COPD knowledge questionnaire, percentage correctly answered questions (CIROPD %correct )) (<60% (OR = 1.00); 60%-75%: (OR = 0.30); >75%: (OR = 1.94), eCOPD history (OR = 9.98), and care dependency scale (CDS) total score (OR = 1.12). This model was well calibrated (goodness-of-fit test: p = 0.91) and correctly classified 79.7% of the patients. Conclusion: A combination of TUG-time, eCOPD-related admission(s) prior to baseline, currently smoking, FVC, CDS total score, and CIROPD %correct allows clinicians to predict the probability of an eCOPD-related hospitalization.

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Prediction models for exacerbations in different COPD patient populations: comparing results of five large data sources

Cited by 39 publications

References 35 publications

<p>FEV<sub>1</sub> is a stronger mortality predictor than FVC in patients with moderate COPD and with an increased risk for cardiovascular disease</p>

<p>FEV<sub>1</sub> is a stronger mortality predictor than FVC in patients with moderate COPD and with an increased risk for cardiovascular disease</p>

Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life

Physical, Psychological, and Social Factors Associated with Exacerbation-Related Hospitalization in Patients with COPD

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