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The Relation Between Clinical Phenotypes, GOLD Groups/Stages and Mortality in COPD Patients - A Prospective
Kristian Brat1,2, Michal Svoboda2,3, Jaromir Zatloukal4,5
1Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic.
Summary
Certain chronic obstructive pulmonary disease (COPD) phenotypes significantly increase mortality risk. Combining multiple COPD phenotypes, such as emphysema, cachexia, and frequent exacerbations, amplifies this risk, indicating a poorer prognosis.
Area of Science:
- Pulmonology
- Clinical Medicine
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) phenotyping identifies distinct clinical, pulmonary, and extrapulmonary features.
- Understanding these phenotypes is crucial for assessing disease progression and patient outcomes.
Purpose of the Study:
- To evaluate the prognostic value of "Czech" and "Spanish" COPD phenotypes and their combinations.
- To assess the predictive utility of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages and groups for long-term mortality risk.
Main Methods:
- Utilized data from the Czech Multicenter Research Database (CMRD) of COPD.
- Employed Kaplan-Meier (KM) estimates for 60-month mortality assessment.
- Applied classification and regression tree (CART) analysis to identify key mortality risk factors and confounders.
Main Results:
- Bronchiectasis/COPD overlap, frequent exacerbator, cachexia, and emphysematous phenotypes were linked to increased mortality.
- The combination of emphysema, cachexia, and frequent exacerbations demonstrated the poorest prognosis (HR 3.075).
- "Spanish" phenotypes AE CB and AE non-CB also showed significantly higher mortality risks (HR 1.787 and 2.001, respectively).
Conclusions:
- Specific "Czech" and "Spanish" COPD phenotypes are associated with elevated long-term mortality risk.
- The co-occurrence of multiple phenotypes, particularly emphysematous, cachectic, and frequent exacerbator types, significantly amplifies mortality risk.
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