Alter Peter, Kahnert Kathrin, Trudzinski Franziska C, Bals Robert, Watz Henrik, Speicher Tim, Söhler Sandra, Rabe Klaus F, Wouters Emiel F M, Vogelmeier Claus F, Jörres Rudolf A
Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), German Center for Lung Research (DZL), Marburg, Germany.
Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany.
Int J Chron Obstruct Pulmon Dis. 2024 Dec 5;19:2629-2638. doi: 10.2147/COPD.S475112. eCollection 2024.
The COPD Assessment Test (CAT) comprises eight questions. We evaluated the information that each of the questions and the total score contributed to outcomes and characteristics of chronic obstructive lung disease (COPD), including their dependence on smoking status.
Patients with COPD of the COSYCONET cohort with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4 and the former grade 0 were included. The evaluated outcomes included mortality, exacerbation risk, the comorbidities asthma, cardiac disease (coronary artery disease/heart failure), osteoporosis, and emphysema, for which a reduction in carbon monoxide transfer coefficient (KCO) <55% predicted was considered as marker. Analyses were performed by Cox proportional hazard or logistic multiple regression analyses separately for smokers and nonsmokers.
In total, 2509 patients had complete data, among them 1884 nonsmokers (ex or never; 38.4% female; mean age±SD 66.1±8.5 years) and 625 current smokers (45.1% female, 61.6±7.9 years). The pattern of responses to the single questions of the CAT differed between outcome variables, as well as between smokers and nonsmokers, but in most cases the total score was superior to the single items. The CAT total score was associated with mortality (p<0.05) only in nonsmokers, while for exacerbation frequency/severity, it was of about equal importance in smokers and nonsmokers. Regarding KCO, the total score was indicative (p<0.05) only in nonsmokers. Particularly in smokers, single items could show opposite signs of their coefficients which therefore largely cancelled in the total score.
Our results show in detail for which outcomes single items are informative in nonsmokers and current smokers with COPD, overall being more informative in nonsmokers. Only regarding exacerbation risk, the predictive value was similar in both groups. These results might be helpful to extract as much as possible information from a COPD questionnaire that is often part of routine assessment.
NCT01245933.
慢性阻塞性肺疾病评估测试（CAT）由八个问题组成。我们评估了每个问题及总分对慢性阻塞性肺疾病（COPD）的结局和特征的贡献，包括它们对吸烟状态的依赖性。
纳入COSYCONET队列中慢性阻塞性肺疾病全球倡议（GOLD）1-4级及原0级的患者。评估的结局包括死亡率、急性加重风险、合并症哮喘、心脏病（冠状动脉疾病/心力衰竭）、骨质疏松症和肺气肿，其中一氧化碳转运系数（KCO）下降<55%被视为预测指标。分别对吸烟者和非吸烟者进行Cox比例风险分析或逻辑多元回归分析。
共有2509例患者有完整数据，其中1884例非吸烟者（已戒烟或从不吸烟；38.4%为女性；平均年龄±标准差66.1±8.5岁）和625例当前吸烟者（45.1%为女性，61.6±7.9岁）。CAT单个问题的回答模式在结局变量之间以及吸烟者和非吸烟者之间有所不同，但在大多数情况下，总分优于单个项目。CAT总分仅在非吸烟者中与死亡率相关（p<0.05），而对于急性加重频率/严重程度，在吸烟者和非吸烟者中重要性大致相同。关于KCO，总分仅在非吸烟者中具有指示性（p<0.05）。特别是在吸烟者中，单个项目的系数可能显示相反的符号，因此在总分中基本抵消。
我们的结果详细显示了单个项目对COPD非吸烟者和当前吸烟者的哪些结局具有信息价值，总体而言在非吸烟者中信息更多。仅关于急性加重风险，两组的预测价值相似。这些结果可能有助于从通常作为常规评估一部分的COPD问卷中尽可能多地提取信息。
NCT01245933。
