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"High-Risk" Clinical and Inflammatory Clusters in COPD of Chinese Descent
Pei Yee Tiew1, Fanny Wai San Ko2, Jayanth Kumar Narayana3
1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Insights
Researchers identified five distinct clusters of Chinese patients with Chronic Obstructive Pulmonary Disease (COPD), with cardiovascular and tuberculosis clusters showing higher mortality and inflammation. This highlights the need for targeted interventions in COPD management.
Area of Science:
- Pulmonary Medicine
- Clinical Research
- Genetics and Genomics
Background:
- Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous condition with significant prevalence in Chinese populations across Southeast Asia.
- Limited understanding exists regarding distinct COPD patient clusters and their prognostic implications within this demographic.
- This study addresses the need to identify COPD subtypes and their association with systemic inflammation and clinical outcomes in Chinese patients.
Purpose of the Study:
- To determine if distinct clusters of Chinese patients with COPD exist.
- To investigate the association of these clusters with systemic inflammation.
- To evaluate the prognostic outcomes, including mortality, associated with identified COPD patient clusters.
Main Methods:
- Prospective recruitment of 1,480 Chinese patients with stable COPD across six hospitals in Singapore, Malaysia, and Hong Kong.
- Unsupervised hierarchical clustering of clinical data, including comorbidities, followed by validation to identify patient clusters.
- Systemic cytokine assessments in a subset of patients (n=336) to characterize inflammatory patterns within clusters.
Main Results:
- Five distinct COPD patient clusters were identified: ex-tuberculosis (TB), diabetic, low comorbidity-low risk, low comorbidity-high risk, and cardiovascular.
- The cardiovascular and ex-TB clusters exhibited the highest mortality rates, independent of Global Initiative for Chronic Obstructive Lung Disease (GOLD) assessment.
- These high-mortality clusters demonstrated diverse cytokine patterns and complex inflammatory networks.
Conclusions:
- Distinct clusters of Chinese COPD patients exist, with two identified as high-risk.
- Cardiovascular and ex-TB clusters are associated with high mortality, significant inflammation, and complex inflammatory networks.
- Clinical and inflammatory risk stratification is recommended for targeted interventions to improve outcomes in Chinese COPD patients.
Background:
COPD is a heterogeneous disease demonstrating inter-individual variation. A high COPD prevalence in Chinese populations is described, but little is known about disease clusters and prognostic outcomes in the Chinese population across Southeast Asia. We aim to determine if clusters of Chinese patients with COPD exist and their association with systemic inflammation and clinical outcomes.
Research Question:
We aim to determine if clusters of Chinese patients with COPD exist and their association with clinical outcomes and inflammation.
Study Design And Methods:
Chinese patients with stable COPD were prospectively recruited into two cohorts (derivation and validation) from six hospitals across three Southeast Asian countries (Singapore, Malaysia, and Hong Kong; n = 1,480). Each patient was followed more than 2 years. Clinical data (including co-morbidities) were employed in unsupervised hierarchical clustering (followed by validation) to determine the existence of patient clusters and their prognostic outcome. Accompanying systemic cytokine assessments were performed in a subset (n = 336) of patients with COPD to determine if inflammatory patterns and associated networks characterized the derived clusters.
Results:
Five patient clusters were identified including: (1) ex-TB, (2) diabetic, (3) low comorbidity: low-risk, (4) low comorbidity: high-risk, and (5) cardiovascular. The cardiovascular and ex-TB clusters demonstrate highest mortality (independent of Global Initiative for Chronic Obstructive Lung Disease assessment) and illustrate diverse cytokine patterns with complex inflammatory networks.
Interpretation:
We describe clusters of Chinese patients with COPD, two of which represent high-risk clusters. The cardiovascular and ex-TB patient clusters exhibit high mortality, significant inflammation, and complex cytokine networks. Clinical and inflammatory risk stratification of Chinese patients with COPD should be considered for targeted intervention to improve disease outcomes.
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