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Predictors of mortality in patients with COPD after 9 years
Robson Prudente1, Estefânia Aparecida Thomé Franco2, Carolina Bonfanti Mesquita1
1Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo Brazil, robsonapp@hcfmb.unesp.br.
Insights
This 9-year study found that high BODE index scores, increased Charlson Comorbidity Index, frequent exacerbations, and low body mass index (BMI) predict mortality in COPD patients. These factors help identify individuals at higher risk for death from chronic obstructive pulmonary disease.
Area of Science:
- Pulmonology
- Clinical Medicine
- Epidemiology
Background:
- Chronic Obstructive Pulmonary Disease (COPD) is a major global cause of illness and death.
- Varied clinical and laboratory features influence COPD mortality over time.
- Predictors of long-term mortality in COPD patients require further investigation.
Purpose of the Study:
- To identify predictors of mortality in patients with COPD over a 9-year period.
- To assess the impact of baseline clinical and physiological parameters on long-term survival.
- To evaluate the prognostic value of the BODE index and other clinical factors.
Main Methods:
- A cohort of 133 COPD patients was assessed at baseline.
- Evaluated parameters included spirometry, pulse oximetry (SpO2), body composition, dyspnea intensity, 6-minute walk test (6MWT), and Charlson Comorbidity Index (CCI).
- Mortality predictors were analyzed over 9 years, considering BODE index, CCI, and exacerbation frequency.
Main Results:
- 110 patients were included in the final analysis.
- Higher BODE index classes (2, 3, and 4) were associated with significantly increased mortality risk compared to class 1.
- Increased CCI and a higher frequency of exacerbations in the first 3 years also predicted higher mortality.
- A Body Mass Index (BMI) ≤21 kg/m² was independently associated with an increased risk of death.
Conclusions:
- High BODE index, elevated CCI, frequent exacerbations, and low BMI (≤21 kg/m²) are significant predictors of 9-year mortality in COPD patients.
- These findings aid in risk stratification and clinical management of COPD.
- The study highlights the importance of a multidimensional assessment including BODE components for prognosis.
Background:
COPD is one of the leading causes of morbidity and mortality in the world; however, the most varied amounts of clinical and laboratory characteristics acts in different ways in the mortality among over time. Therefore, this study aimed to evaluate the predictors of mortality in patients with COPD after 9 years.
Patients And Methods:
One hundred and thirty-three patients with COPD were assessed at baseline by spirometry, pulse oximetry (SpO2), body composition, intensity of dyspnea, distance walked in the 6-minute walk test (6MWT), and Charlson Comorbidity Index (CCI).
Results:
After 9 years, it was not possible to identify the lifetime of 4 patients who died and of 19 patients who stopped follow-up; thus, 110 patients were included in the analysis of predictors of mortality (67% male, 65±9 years old, and FEV1: 52.5 [40%-73%]). Male sex, age, SpO2, Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, and frequency of exacerbations in the first 3 years of follow-up were considered in the model. Patients classified at baseline with BODE class 2 (HR: 2.62, 95% CI: 1.36-5.04; P=0.004), BODE class 3 (HR: 2.54, 95% CI: 1.15-5.61; P=0.02), and BODE class 4 (HR: 15.35, 95% CI: 3.11-75.75; P=0.001) showed increased risk of death compared to those with BODE class 1. The CCI (HR: 1.29, 95% CI: 1.00-1.68; P=0.04) and the number of exacerbations in the first 3 years (HR: 1.32, 95% CI: 1.00-1.76; P=0.04) also showed increased risk of death. By replacing the BODE index for the variables that compose it, those with body mass index ≤21 kg/m2 showed increased risk of death compared to those with body mass index (BMI)>21 kg/m2 (HR: 2.70, 95% CI: 1.38-5.25; P=0.003).
Conclusion:
After 9 years, we identified that those with high BODE index, greater CCI, greater frequency of exacerbations in the first 3 years, and BMI ≤21 kg/m2 showed increased risk of death.
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