Influence of Comorbidities on the Survival of COPD Patients According to Phenotypes

Abstract

Zichen Ji,1,2 Julio Hernández-Vázquez,3 Irene Milagros Domínguez-Zabaleta,1 Ziyi Xia,2 José María Bellón-Cano,4 Virginia Gallo-González,1 Ismael Ali-García,3 Carmen Matesanz-Ruiz,3 Ana López-de-Andrés,5 Rodrigo Jiménez-García,6 María Jesús Buendía-García,3 Ángela Gómez-Sacristán,7 Walther Iván Girón-Matute,1,2,7 Luis Puente-Maestu,1,2,7 Javier de Miguel-Díez1,2,7 1Pulmonology Service, Gregorio Marañón General University Hospital, Madrid, Spain; 2Faculty of Medicine, Complutense University of Madrid, Madrid, Spain; 3Pulmonology Section, Infanta Leonor University Hospital, Madrid, Spain; 4Research Support Service, Gregorio Marañón Health Research Institute, Madrid, Spain; 5Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain; 6Public Health and Maternal and Child Health Department, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain; 7Gregorio Marañón Health Research Institute, Madrid, SpainCorrespondence: Zichen JiPulmonology Service, Gregorio Marañón University General Hospital, Madrid 28007, SpainTel [phone]Email [email protected]: Chronic obstructive pulmonary disease (COPD) usually occurs alongside other conditions. Few studies on comorbidities have taken into account the phenotypes of COPD patients. The objective of this study is to evaluate the prevalence of comorbidities included in the Charlson index and their influence on the survival of patients with COPD, taking phenotypes into account.Methods: An observational study was conducted on a group of 273 patients who had COPD and underwent spirometry in the first half of 2011, with a median prospective follow-up period of 68.15 months. The survival of these patients was analyzed according to the presence of various comorbidities.Results: Of the 273 patients, 93 (34.1%) died within the follow-up period. An increased presence of chronic ischemic heart disease (CIHD), chronic heart failure (CHF), chronic kidney disease (CKD), and malignancy was found in deceased patients. All of these conditions shorten the survival of COPD patients globally; however, when considering phenotypes, only CHF influences the exacerbator with chronic bronchitis phenotype, CKD influences the non-exacerbator phenotype, and malignancy influences the positive bronchodilator test (BDT) and exacerbator with chronic bronchitis phenotypes. In the multivariate model, advanced age (hazard ratio, HR: 1.05; p=0.001), CHF (HR: 1.74; p=0.030), and the presence of malignancy (HR: 1.78; p=0.010) were observed as independent mortality risk factors.Conclusion: The survival is shorter in the presence of CIHD in overall COPD patients and also CHF, CKD, and malignancy for certain phenotypes. It is important to pay attention to these comorbidities in the comprehensive care of COPD patients.Keywords: COPD, phenotypes, comorbidities, risk factors, mortality, survival

Keywords

• copd
• phenotypes
• comorbidities
• risk factors
• mortality
• survival