Subtypes of patients experiencing exacerbations of COPD and associations with outcomes
Arostegui, Inmaculada (Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC))
Esteban, Cristobal (Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC))
García Gutierrez, Susana (Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC))
Baré i Mañas, Marisa (Unidad de Epidemiología Clínica, Corporación Parc Tauli)
Fernández de Larrea, Nerea (Subdirección General de Tecnología e Innovación Sanitarias, Consejería de Sanidad de la Comunidad de Madrid)
Briones, Eduardo (Distrito Sanitario Atención Primaria)
Quintana, Jose M. (Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC))
Universitat Autònoma de Barcelona. Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva

Date:	2014
Abstract:	Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.
Note:	Altres ajuts: Universidad del País Vasco UPV/EHU (GIU10/21, UFI11/52), Departamento de Educación, Política Lingüística y Cultura del Gobierno Vasco (IT620-13), Departamento de Sanidad del Gobierno Vasco (2012111008)
Note:	Número d'acord de subvenció MINECO/MTM2010-14913
Note:	Número d'acord de subvenció FIS/PI06/1010
Note:	Número d'acord de subvenció FIS/PI06/1017
Note:	Número d'acord de subvenció FIS/PI06/714
Note:	Número d'acord de subvenció FIS/PI06/0326
Note:	Número d'acord de subvenció FIS/PI06/00664
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès.
Document:	article ; recerca ; publishedVersion
Subject:	Aged ; Cohort Studies ; Disease Progression ; Emergency Service, Hospital ; Female ; Humans ; Male ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; Spain
Published in:	PloS one, Vol. 9 Núm. 6 (march 2014) , p. e98580, ISSN 1932-6203

DOI: 10.1371/journal.pone.0098580
PMID: 24892936

9 p, 625.9 KB

The record appears in these collections:
Articles > Research articles
Articles > Published articles