Validation of Clinical COPD Phenotypes for Prognosis of Long-Term Mortality in Swedish and Dutch Cohorts

• Published in: Chronic obstructive pulmonary disease Vol. 19; no. 1; pp. 330 - 338
• Main Authors: Gagatek, S., Wijnant, S. R. A., Ställberg, B., Lisspers, K., Brusselle, G., Zhou, X., Hasselgren, M., Montgomeryi, S., Sundhj, J., Janson, C., Emilsson, Ö., Lahousse, L., Malinovschi, A.
• Format: Journal Article
• Language: English
• Published: Taylor & Francis 31-12-2022; Taylor & Francis Group
• Subjects: comorbidities; COPD; epidemiology; mortality; phenotypes
• ISSN: 1541-2555; 1541-2563; 1541-2563
• DOI: 10.1080/15412555.2022.2039608

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with variable mortality risk. The aim of our investigation was to validate a simple clinical algorithm for long-term mortality previously proposed by Burgel et al. in 2017. Subjects with COPD from two cohorts, the Swedish PRAXIS study (n = 784, mean age (standard deviation (SD)) 64.0 years (7.5), 42% males) and the Rotterdam Study (n = 735, mean age (SD) 72 years (9.2), 57% males), were included. Five clinical clusters were derived from baseline data on age, body mass index, dyspnoea grade, pulmonary function and comorbidity (cardiovascular disease/diabetes). Cox models were used to study associations with 9-year mortality. The distribution of clinical clusters (1-5) was 29%/45%/8%/6%/12% in the PRAXIS study and 23%/26%/36%/0%/15% in the Rotterdam Study. The cumulative proportion of deaths at the 9-year follow-up was highest in clusters 1 (65%) and 4 (72%), and lowest in cluster 5 (10%) in the PRAXIS study. In the Rotterdam Study, cluster 1 (44%) had the highest cumulative mortality and cluster 5 (5%) the lowest. Compared with cluster 5, the meta-analysed age- and sex-adjusted hazard ratio (95% confidence interval) for cluster 1 was 6.37 (3.94-10.32) and those for clusters 2 and 3 were 2.61 (1.58-4.32) and 3.06 (1.82-5.13), respectively. Burgel's clinical clusters can be used to predict long-term mortality risk. Clusters 1 and 4 are associated with the poorest prognosis, cluster 5 with the best prognosis and clusters 2 and 3 with intermediate prognosis in two independent cohorts from Sweden and the Netherlands.
Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2039608 .