Prediction of first acute exacerbation using COPD subtypes identified by cluster analysis
- 주제(키워드) clustering , prognosis , phenotype , asthma-COPD overlap , exacerbation , comorbidity
- 주제(기타) Respiratory System
- 설명문(일반) [Yoon, Hee-Young; Park, So Young; Lee, Jin Hwa] Ewha Womans Univ, Ewha Womans Seoul Hosp, Coll Med, Dept Internal Med,Div Pulm & Crit Care Med, Seoul, South Korea; [Lee, Chang Hoon] Seoul Natl Univ Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Seoul, South Korea; [Byun, Min-Kwang] Yonsei Univ, Gangnam Severance Hosp, Yonsei Univ Hlth Syst, Coll Med,Dept Internal Med,Div Pulm Med, Seoul, South Korea; [Na, Joo Ock] Soonchunhyang Univ, Coll Med, Dept Internal Med, Div Pulmonol, Cheonan, South Korea; [Lee, Jae Seung] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Pulm & Crit Care Med, Seoul, South Korea; [Lee, Won-Yeon] Yonsei Univ, Wonju Coll Med, Wonju Christian Hosp, Dept Internal Med, Wonju, South Korea; [Yoo, Kwang Ha] Konkuk Univ, Coll Med, Dept Internal Med, Seoul, South Korea; [Jung, Ki-Suck] Hallym Univ, Coll Med, Med Ctr, Dept Internal Med,Div Pulm Allergy & Crit Care Me, Anyang, South Korea
- 후원정보 Korean Acad Tuberculosis & Respiratory Dis
- 등재 SCIE, SCOPUS
- OA유형 gold, Green Published, Green Submitted
- 발행기관 DOVE MEDICAL PRESS LTD
- 발행년도 2019
- 회의명 Annual Autumn Meeting of the Korean-Academy-of Tuberculosis-and-Respiratory-Diseases
- 개최지 Seoul, SOUTH KOREA
- 일자 10-11월-18
- URI http://www.dcollection.net/handler/ewha/000000159894
- 본문언어 영어
- Published As http://dx.doi.org/10.2147/COPD.S205517
- PubMed https://pubmed.ncbi.nlm.nih.gov/31388298
초록/요약
Purpose: In patients with COPD, acute exacerbation (AE) is not only an important determinant of prognosis, but also an important factor in choosing therapeutic agents. In this study, we evaluated the usefulness of COPD subtypes identified through cluster analysis to predict the first AE. Patients and methods: Among COPD patients in the Korea COPD Subgroup Study (KOCOSS) cohort, 1,195 who had follow-up data for AE were included in our study. We selected seven variables for cluster analysis - age, body mass index, smoking status, history of asthma, COPD assessment test (CAT) score, post-bronchodilator (BD) FEV1 % predicted, and diffusing capacity of carbon monoxide % predicted. Results: K-means clustering identified four clusters for COPD that we named putative asthma-COPD overlap (ACO), mild COPD, moderate COPD, and severe COPD subtypes. The ACO group (n=196) showed the second-best post-BD FEV1 (75.5% vs 80.9%[mild COPD, n=313] vs 52.4% [moderate COPD, n=345] vs 46.7% [severe COPD, n=341] predicted), the longest 6-min walking distance (424 m vs 405 m vs 389 m vs 365 m), and the lowest CATscore (12.2 vs 13.7 vs 15.6 vs 17.5) among the four groups. ACO group had greater risk for first AE compared to the mild COPD group (HR, 1.683; 95% CI, 1.175-2.410). The moderate COPD and severe COPD group HR values were 1.587 (95% CI, 1.145-2.200) and 1.664 (95% CI, 1.203-2.302), respectively. In addition, St. George's Respiratory Questionnaire score (HR: 1.019; 95% CI, 1.014-1.024) and gastroesophageal reflux disease were independent factors associated with the first AE (HR: 1.535; 95% CI, 1.116-2.112). Conclusion: Our cluster analysis revealed an exacerbator subtype of COPD independent of FEV1. Since these patients are susceptible to AE, a more aggressive treatment strategy is needed in these patients.
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