Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany.
Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
Int J Chron Obstruct Pulmon Dis. 2022 Jul 29;17:1703-1713. doi: 10.2147/COPD.S364812. eCollection 2022.
Multimorbidity plays an important role in chronic obstructive pulmonary disease (COPD) but is also a feature of ageing. We estimated to what extent increases in the prevalence of multimorbidity over time are attributable to COPD progression compared to increasing patient age.
Patients with COPD from the long-term COSYCONET (COPD and Systemic Consequences - Comorbidities Network) cohort with four follow-up visits were included in this analysis. At each visit, symptoms, exacerbation history, quality of life and lung function were assessed, along with the comorbidities heart failure (HF), coronary artery disease (CAD), peripheral arterial disease (PAD), hypertension, sleep apnea, diabetes mellitus, hyperlipidemia, hyperuricemia and osteoporosis. Using longitudinal logistic regression analysis, we determined what proportion of the increase in the prevalence of comorbidities could be attributed to patients' age or to the progression of COPD over visits.
Of 2030 patients at baseline, 878 completed four follow-up visits (up to 4.5 years). CAD prevalence increased over time, with similar effects attributable to the 4.5-year follow-up, used as indicator of COPD progression, and to a 5-year increase in patients' age. The prevalence of HF, diabetes, hyperlipidemia, hyperuricemia, osteoporosis and sleep apnea showed stronger contributions of COPD progression than of age; in contrast, age dominated for hypertension and PAD. There were different relationships to patients' characteristics including BMI and sex. The results were not critically dependent on the duration of COPD prior to enrolment, or the inclusion of patients with all four follow-up visits vs those attending only at least one of them.
Analyzing the increasing prevalence of multimorbidity in COPD over time, we separated age-independent contributions, probably reflecting intrinsic COPD-related disease progression, from age-dependent contributions. This distinction might be useful for the individual assessment of disease progression in COPD.
多种合并症在慢性阻塞性肺疾病（COPD）中起着重要作用，但也是衰老的特征。我们估计，随着时间的推移，多种合并症的患病率增加在多大程度上归因于 COPD 的进展，而不是患者年龄的增加。
本分析纳入了来自长期 COSYCONET（COPD 和系统后果-合并症网络）队列的 COPD 患者，这些患者有四次随访。在每次随访中，评估了症状、加重史、生活质量和肺功能，以及合并症心力衰竭（HF）、冠状动脉疾病（CAD）、外周动脉疾病（PAD）、高血压、睡眠呼吸暂停、糖尿病、高脂血症、高尿酸血症和骨质疏松症。通过纵向逻辑回归分析，我们确定了在合并症患病率的增加中，有多少可以归因于患者的年龄或 COPD 在随访中的进展。
在基线时的 2030 名患者中，有 878 名完成了四次随访（最长 4.5 年）。CAD 的患病率随着时间的推移而增加，使用 4.5 年的随访作为 COPD 进展的指标，以及患者年龄增加 5 年，都有类似的影响。HF、糖尿病、高脂血症、高尿酸血症、骨质疏松症和睡眠呼吸暂停的患病率与 COPD 进展的关系比年龄更强；相反，年龄对高血压和 PAD 起主导作用。这些关系与患者的特征（包括 BMI 和性别）不同。结果不受 COPD 发病前的持续时间以及包括所有四次随访的患者与仅至少参加一次随访的患者的影响。
分析 COPD 患者随着时间的推移多种合并症患病率的增加，我们将独立于年龄的贡献与依赖于年龄的贡献分开，这可能反映了与 COPD 相关的固有疾病进展。这种区分对于 COPD 患者疾病进展的个体评估可能是有用的。
