PURPOSE: The Phenotypes of COPD in Central and Eastern Europe (POPE) study assessed the prevalence and clinical characteristics of four clinical COPD phenotypes, but not mortality. This retrospective analysis of the POPE study (RETRO-POPE) investigated the relationship between all-cause mortality and patient characteristics using two grouping methods: clinical phenotyping (as in POPE) and Burgel clustering, to better identify high-risk patients. PATIENTS AND METHODS: The two largest POPE study patient cohorts (Czech Republic and Serbia) were categorized into one of four clinical phenotypes (acute exacerbators [with/without chronic bronchitis], non-exacerbators, asthma-COPD overlap), and one of five Burgel clusters based on comorbidities, lung function, age, body mass index (BMI) and dyspnea (very severe comorbid, very severe respiratory, moderate-to-severe respiratory, moderate-to-severe comorbid/obese, and mild respiratory). Patients were followed-up for approximately 7 years for survival status. RESULTS: Overall, 801 of 1,003 screened patients had sufficient data for analysis. Of these, 440 patients (54.9%) were alive and 361 (45.1%) had died at the end of follow-up. Analysis of survival by clinical phenotype showed no significant differences between the phenotypes (P=0.211). However, Burgel clustering demonstrated significant differences in survival between clusters (P<0.001), with patients in the "very severe comorbid" and "very severe respiratory" clusters most likely to die. Overall survival was not significantly different between Serbia and the Czech Republic after adjustment for age, BMI, comorbidities and forced expiratory volume in 1 second (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.65-0.99; P=0.036 [unadjusted]; HR 0.88, 95% CI 0.7-1.1; P=0.257 [adjusted]). The most common causes of death were respiratory-related (36.8%), followed by cardiovascular (25.2%) then neoplasm (15.2%). CONCLUSION: Patient clusters based on comorbidities, lung function, age, BMI and dyspnea were more likely to show differences in COPD mortality risk than phenotypes defined by exacerbation history and presence/absence of chronic bronchitis and/or asthmatic features.

Clinic for Pulmonary Diseases Clinical Center of Serbia Belgrade Serbia

Clinic for Pulmonology University Clinical Center Kragujevac Kragujevac Serbia

Clinic for Tuberculosis and Interstitial Lung Diseases PolyClinic Department Institute for Pulmonary Diseases of Vojvodina Sremska Kamenica Serbia

Department of Internal Medicine Faculty of Medical Sciences University of Kragujevac Kragujevac Serbia

Department of Pneumology University Hospital Hradec Kralove Czech Republic

Faculty of Medicine Hradec Kralove Charles University Hradec Kralove Czech Republic

Faculty of Medicine University of Belgrade Belgrade Serbia

Faculty of Medicine University of Novi Sad Novi Sad Serbia

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

Institute of Biostatistics and Analyses Ltd Brno Czech Republic

Karl Landsteiner Institute for Lung Research and Pulmonary Oncology Klinik Floridsdorf Vienna Health Care Group Vienna Austria

Medicine Department Boehringer Ingelheim Serbia d o o Beograd Belgrade Serbia

Outpatient Chest Clinic Plicni Stredisko Teplice Ltd Teplice Czech Republic

Outpatient Chest Clinic PNEUMO KV Ltd Karlovy Vary Czech Republic

Outpatient Department of Pneumology Alveolus APRO MED Ostrava Czech Republic

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