The Relation Between Clinical Phenotypes, GOLD Groups/Stages and Mortality in COPD Patients - A Prospective Multicenter Study.

The concept of phenotyping emerged, reflecting specific clinical, pulmonary and extrapulmonary features of each particular chronic obstructive pulmonary disease (COPD) case. Our aim was to analyze prognostic utility of: "Czech" COPD phenotypes and their most frequent combinations, "Spanish" phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages + groups in relation to long-term mortality risk. Data were extracted from the Czech Multicenter Research Database (CMRD) of COPD. Kaplan-Meier (KM) estimates (at 60 months from inclusion) were used for mortality assessment. Survival rates were calculated for the six elementary "Czech" phenotypes and their most frequent and relevant combinations, "Spanish" phenotypes, GOLD grades and groups. Statistically significant differences were tested by Log Rank test. An analysis of factors underlying mortality risk (the role of confounders) has been assessed with the use of classification and regression tree (CART) analysis. Basic factors showing significant differences between deceased and living patients were entered into the CART model. This showed six different risk groups, the differences in risk were tested by a Log Rank test. The cohort (n=720) was 73.1% men, with a mean age of 66.6 years and mean FEV Certain phenotypes ("Czech" or "Spanish") of COPD are associated with higher risk of death. Co-presence of multiple phenotypes (emphysematous plus cachectic plus frequent exacerbator) in a single individual was associated with amplified risk of mortality.

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© 2021 Brat et al.

Déclaration de conflit d'intérêts

Dr Kristian Brat reports personal fees from Boehringer Ingelheim, AstraZeneca, Chiesi, payments for advisory boards from Boehringer Ingelheim and Chiesi; educational support from Boehringer Ingelheim, Angelini, and CSL Behring, outside the submitted work. Dr Jaromir Zatloukal reports personal fees from Boehringer-Ingelheim, GlaxoSmithKline, AstraZeneca, Chiesi, and Angelini, outside the submitted work. Dr Marek Plutinsky reports lecture fees from Boehringer Ingelheim, Berlin Chemie, and CSL Behring; educational support from Boehringer Ingelheim and CSL Behring, outside the submitted work. Prof. Dr. Vladimir Koblizek reports COPD research funding from Boehringer Ingelheim and Novartis, and received consulting/lectures payments from Angelini, AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, GSK, Novartis and Chiesi pertaining to the COPD field within the past 3 years. The authors report no other conflicts of interest in this work.