Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic.
Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Int J Chron Obstruct Pulmon Dis. 2021 Apr 28;16:1171-1182. doi: 10.2147/COPD.S297087. eCollection 2021.
The concept of phenotyping emerged, reflecting specific clinical, pulmonary and extrapulmonary features of each particular chronic obstructive pulmonary disease (COPD) case. Our aim was to analyze prognostic utility of: "Czech" COPD phenotypes and their most frequent combinations, "Spanish" phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages + groups in relation to long-term mortality risk.
Data were extracted from the Czech Multicenter Research Database (CMRD) of COPD. Kaplan-Meier (KM) estimates (at 60 months from inclusion) were used for mortality assessment. Survival rates were calculated for the six elementary "Czech" phenotypes and their most frequent and relevant combinations, "Spanish" phenotypes, GOLD grades and groups. Statistically significant differences were tested by Log Rank test. An analysis of factors underlying mortality risk (the role of confounders) has been assessed with the use of classification and regression tree (CART) analysis. Basic factors showing significant differences between deceased and living patients were entered into the CART model. This showed six different risk groups, the differences in risk were tested by a Log Rank test.
The cohort (n=720) was 73.1% men, with a mean age of 66.6 years and mean FEV 44.4% pred. KM estimates showed bronchiectases/COPD overlap (HR 1.425, p=0.045), frequent exacerbator (HR 1.58, p<0.001), cachexia (HR 2.262, p<0.001) and emphysematous (HR 1.786, p=0.015) phenotypes associated with higher mortality risk. Co-presence of multiple phenotypes in a single patient had additive effect on risk; combination of emphysema, cachexia and frequent exacerbations translated into poorest prognosis (HR 3.075; p<0.001). Of the "Spanish" phenotypes, AE CB and AE non-CB were associated with greater risk of mortality (HR 1.787 and 2.001; both p=0.001). FEV% pred., cachexia and chronic heart failure in patient history were the major underlying factors determining mortality risk in our cohort.
Certain phenotypes ("Czech" or "Spanish") of COPD are associated with higher risk of death. Co-presence of multiple phenotypes (emphysematous plus cachectic plus frequent exacerbator) in a single individual was associated with amplified risk of mortality.
表型概念的出现反映了每个特定慢性阻塞性肺疾病（COPD）病例的具体临床、肺部和肺外特征。我们的目的是分析以下因素的预后效用：“捷克”COPD 表型及其最常见的组合、“西班牙”表型、全球慢性阻塞性肺疾病倡议（GOLD）分期+组与长期死亡率风险的关系。
从捷克多中心 COPD 研究数据库（CMRD）中提取数据。使用 Kaplan-Meier（KM）估计值（纳入后 60 个月）评估死亡率。为六种基本的“捷克”表型及其最常见和相关的组合、“西班牙”表型、GOLD 分级和组计算生存率。通过对数秩检验测试统计学上的显著性差异。使用分类和回归树（CART）分析评估死亡率潜在因素（混杂因素的作用）。将基本因素（在死亡和存活患者之间有显著差异的因素）输入 CART 模型。该模型显示了六个不同的风险组，通过对数秩检验测试风险差异。
该队列（n=720）中 73.1%为男性，平均年龄为 66.6 岁，FEV 44.4%预测值。KM 估计值显示支扩/COPD 重叠（HR 1.425，p=0.045）、频繁急性加重（HR 1.58，p<0.001）、恶病质（HR 2.262，p<0.001）和肺气肿（HR 1.786，p=0.015）表型与更高的死亡率风险相关。单个患者中多种表型的共存对风险有累加效应；肺气肿、恶病质和频繁急性加重的组合预示着最差的预后（HR 3.075；p<0.001）。在“西班牙”表型中，AE CB 和 AE non-CB 与更高的死亡率风险相关（HR 1.787 和 2.001；均 p=0.001）。FEV%预测值、恶病质和患者病史中的慢性心力衰竭是决定我们队列死亡率的主要潜在因素。
某些 COPD 表型（“捷克”或“西班牙”）与死亡风险增加相关。单个个体中多种表型（肺气肿+恶病质+频繁急性加重）共存与死亡率风险增加相关。
