Ter Haar Else A M D, Slebos Dirk-Jan, Klooster Karin, Pouwels Simon D, Hartman Jorine E
University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands.
University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.
ERJ Open Res. 2024 Nov 18;10(6). doi: 10.1183/23120541.00268-2024. eCollection 2024 Nov.
Patients with COPD often present with a significant number of comorbidities, which are thought to be related to a higher mortality risk. Our aim was to investigate the prevalence and impact of comorbidities on survival and quality of life (QoL), specifically in patients with emphysema characterised by severe lung hyperinflation.
Data were prospectively collected from patients who visited our hospital for evaluating their eligibility for a bronchoscopic lung volume reduction treatment and were included in the Groningen Severe COPD cohort (NCT04023409). Comorbidities were patient-reported by a questionnaire and were validated with patients' medical records. QoL was assessed with the St Georges Respiratory Questionnaire.
We included 830 COPD patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III and IV. The total number of comorbidities was an independent predictor of survival when adjusting for other factors influencing survival (HR 1.12, 95% CI 1.05-1.20, p<0.001). Of the individual comorbidities, pulmonary arterial hypertension (HR 1.53, 95% CI 1.01-2.32, p=0.045), low body mass index (HR 1.63, 95% CI 1.16-2.27, p=0.004) and anxiety (HR 1.46, 95% CI 1.11-1.92, p=0.007) were independently associated with worse survival. Moreover, patients having 3, 4 or >5 comorbidities had a significantly (all p<0.05) worse QoL, in comparison to patients without comorbidities.
Our results show that comorbidities were associated with lower survival and poor QoL in emphysema patients characterised by severe hyperinflation. Appropriate treatment of treatable traits, including anxiety, low body mass index and pulmonary arterial hypertension, could lead to a survival benefit and improvement in QoL in this specific patient population.
慢性阻塞性肺疾病（COPD）患者常伴有大量合并症，这些合并症被认为与较高的死亡风险相关。我们的目的是调查合并症的患病率及其对生存率和生活质量（QoL）的影响，特别是在以严重肺过度充气为特征的肺气肿患者中。
前瞻性收集因评估支气管镜肺减容治疗资格而到我院就诊的患者的数据，并将其纳入格罗宁根重度COPD队列（NCT04023409）。合并症通过问卷调查由患者报告，并与患者的病历进行核对。使用圣乔治呼吸问卷评估生活质量。
我们纳入了830例慢性阻塞性肺疾病全球倡议组织（GOLD）III期和IV期的COPD患者。在调整影响生存的其他因素后，合并症总数是生存的独立预测因素（风险比1.12，95%置信区间1.05-1.20，p<0.001）。在个体合并症中，肺动脉高压（风险比1.53，95%置信区间1.01-2.32，p=0.045）、低体重指数（风险比1.63，95%置信区间1.16-2.27，p=0.004）和焦虑（风险比1.46，95%置信区间1.11-1.92，p=0.007）与较差的生存率独立相关。此外，与无合并症的患者相比，有3种、4种或>5种合并症的患者生活质量明显更差（所有p<0.05）。
我们的结果表明，合并症与以严重肺过度充气为特征的肺气肿患者生存率降低和生活质量差相关。对可治疗特征进行适当治疗，包括焦虑、低体重指数和肺动脉高压，可能会使这一特定患者群体的生存率提高，并改善生活质量。
