Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease.

RATIONALE Patients with chronic obstructive pulmonary disease (COPD) are afflicted by comorbidities. Few studies have prospectively evaluated COPD comorbidities and mortality risk. OBJECTIVES To prospectively evaluate COPD comorbidities and mortality risk. METHODS We followed 1,664 patients with COPD in five centers for a median of 51 months. Systematically, 79 comorbidities were recorded. We calculated mortality risk using Cox proportional hazard, and developed a graphic representation of the prevalence and strength of association to mortality in the form of a "comorbidome". A COPD comorbidity index (COPD specific comorbidity test [COTE]) was constructed based on the comorbidities that increase mortality risk using a multivariate analysis. We tested the COTE index as predictor of mortality and explored whether the COTE index added predictive information when used with the validated BODE index. MEASUREMENTS AND MAIN RESULTS Fifteen of 79 comorbidities differed in prevalence between survivors and nonsurvivors. Of those, 12 predicted mortality and were integrated into the COTE index. Increases in the COTE index were associated with an increased risk of death from COPD-related (hazard ratio [HR], 1.13; 95% confidence interval, 1.08-1.18; P < 0.001) and non-COPD-related causes (HR, 1.18; 95% confidence interval, 1.15-1.21; P < 0.001). Further, increases in the BODE and COTE were independently associated with increased risk of death. A COTE score of greater than or equal to 4 points increased by 2.2-fold the risk of death (HR, 2.26-2.68; P < 0.001) in all BODE quartile. CONCLUSIONS Comorbidities are frequent in COPD and 12 of them negatively influence survival. A simple disease-specific comorbidities index (COTE) helps assess mortality risk in patients with COPD.

[1]  M. Cosio,et al.  Lung cancer in patients with chronic obstructive pulmonary disease-- incidence and predicting factors. , 2011, American journal of respiratory and critical care medicine.

[2]  M. Cosio,et al.  Lung cancer in patients with COPD: Incidence and predicting factors , 2011 .

[3]  B. Celli,et al.  Development and validation of a new comorbidity index for COPD , 2011 .

[4]  Stephanie A. Studenski,et al.  Comparative effectiveness research and patients with multiple chronic conditions. , 2011, The New England journal of medicine.

[5]  B. Celli,et al.  Addressing the complexity of chronic obstructive pulmonary disease: from phenotypes and biomarkers to scale-free networks, systems biology, and P4 medicine. , 2011, American journal of respiratory and critical care medicine.

[6]  Katherine P Andriole,et al.  Lung volumes and emphysema in smokers with interstitial lung abnormalities. , 2011, The New England journal of medicine.

[7]  Edwin K Silverman,et al.  Characterisation of COPD heterogeneity in the ECLIPSE cohort , 2010, Respiratory research.

[8]  R. Wise,et al.  Mortality in COPD: Causes, Risk Factors, and Prevention , 2010, COPD.

[9]  B. Celli,et al.  Addressing the Complexity of COPD , 2010 .

[10]  P. Villari,et al.  Comorbidity, Hospitalization, and Mortality in COPD: Results from a Longitudinal Study , 2010, Lung.

[11]  Niels H Chavannes,et al.  Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease: the DOSE Index. , 2009, American journal of respiratory and critical care medicine.

[12]  Ulrike Held,et al.  Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index , 2009, The Lancet.

[13]  Nancy R Cook,et al.  Advances in Measuring the Effect of Individual Predictors of Cardiovascular Risk: The Role of Reclassification Measures , 2009, Annals of Internal Medicine.

[14]  P. J. Barnes,et al.  Systemic manifestations and comorbidities of COPD , 2009, European Respiratory Journal.

[15]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[16]  J. Bourbeau,et al.  Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. , 2008, American journal of respiratory and critical care medicine.

[17]  D. Mannino,et al.  Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD , 2008, European Respiratory Journal.

[18]  Y. Lacasse,et al.  Anxiety and depression in end-stage COPD , 2008, European Respiratory Journal.

[19]  L. Fabbri,et al.  Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation , 2008, Thorax.

[20]  K. Rabe,et al.  Complex chronic comorbidities of COPD , 2008, European Respiratory Journal.

[21]  M. Thun,et al.  Chronic obstructive pulmonary disease is associated with lung cancer mortality in a prospective study of never smokers. , 2007, American journal of respiratory and critical care medicine.

[22]  G. Dupuis,et al.  Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with COPD. , 2007, Chest.

[23]  S. Mody,et al.  Haemoglobin level and its clinical impact in a cohort of patients with COPD , 2007, European Respiratory Journal.

[24]  Robert A Wise,et al.  Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee , 2007, Thorax.

[25]  B. Celli,et al.  Pulmonary Rehabilitation Improves Depression, Anxiety, Dyspnea and Health Status in Patients with COPD , 2007, American journal of physical medicine & rehabilitation.

[26]  V. Backer,et al.  The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. , 2007, Respiratory medicine.

[27]  Avrum Spira,et al.  State of the art. Chronic obstructive pulmonary disease, inflammation, and lung cancer. , 2006, Proceedings of the American Thoracic Society.

[28]  Alan D. Lopez,et al.  Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data , 2006, The Lancet.

[29]  E. Wouters,et al.  COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care. , 2006, Primary care respiratory journal : journal of the General Practice Airways Group.

[30]  T. Gislason,et al.  Depression, anxiety and health status after hospitalisation for COPD: a multicentre study in the Nordic countries. , 2006, Respiratory medicine.

[31]  C. Prefaut,et al.  From muscle disuse to myopathy in COPD: potential contribution of oxidative stress , 2005, European Respiratory Journal.

[32]  S. Sidney,et al.  COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. , 2005, Chest.

[33]  A. Hansell,et al.  Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. , 2005, Chest.

[34]  W. MacNee,et al.  Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper , 2004, European Respiratory Journal.

[35]  Ciro Casanova,et al.  The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. , 2004, The New England journal of medicine.

[36]  F. Dekker,et al.  The influence of COPD on health-related quality of life independent of the influence of comorbidity. , 2003, Journal of clinical epidemiology.

[37]  A. Hansell,et al.  What do chronic obstructive pulmonary disease patients die from? Amultiple cause coding analysis , 2003, European Respiratory Journal.

[38]  D. Mannino,et al.  Low lung function and incident lung cancer in the United States: data From the First National Health and Nutrition Examination Survey follow-up. , 2003, Archives of internal medicine.

[39]  C. Bergsten.  Causes, Risk Factors, and Prevention of Laminitis and Related Claw Lesions , 2003, Acta veterinaria Scandinavica. Supplementum.

[40]  S. Antoniu,et al.  Hospitalizations and mortality in the Lung Health Study , 2002, Expert review of pharmacoeconomics & outcomes research.

[41]  P. Bindels,et al.  Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. , 2001, Journal of clinical epidemiology.

[42]  D. Mannino,et al.  Worldwide epidemiology of chronic obstructive pulmonary disease. , 1999, Current opinion in pulmonary medicine.

[43]  F. Forastiere,et al.  Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. , 1997, The European respiratory journal.

[44]  J. Gold,et al.  Validation of a combined comorbidity index. , 1994, Journal of clinical epidemiology.

[45]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.