Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease.

  title={Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease.},
  author={Lowie E.G.W. Vanfleteren and Martijn A. Spruit and Miriam T. J. Groenen and Swetlana Gaffron and Vanessa P.M. van Empel and Piet L. B. Bruijnzeel and Erica P. A. Rutten and Jos op ‘t Roodt and Emiel F. M. Wouters and Frits M. E. Franssen},
  journal={American journal of respiratory and critical care medicine},
  volume={187 7},
RATIONALE Comorbidities contribute to disease severity and mortality in patients with chronic obstructive pulmonary disease (COPD). Comorbidities have been studied individually and were mostly based on self-reports. The coexistence of objectively identified comorbidities and the role of low-grade systemic inflammation in the pathophysiology of COPD remain to be elucidated. OBJECTIVES To cluster 13 clinically important objectively identified comorbidities, and to characterize the comorbidity… 

Figures and Tables from this paper

P54 Can multi-morbid phenotypes be described in patients with advanced COPD using cluster analysis?

Five multi-morbid phenotypes differed significantly in comorbidity prevalence, airflow limitation, health status and future coronary heart disease risk, however the number of hospital admissions in the past year was similar.

Comorbidities and COPD severity in a clinic-based cohort

This study in a large real-life cohort shows that multimorbidity is common in patients with COPD, mostly significantly associated with symptomatic patients i.e. GOLD B and GOLD D.

Identification of Clinical Phenotypes Using Cluster Analyses in COPD Patients with Multiple Comorbidities

Recent studies that have used cluster analyses for defining phenotypes in observational cohorts of COPD patients are reviewed to review the phenotypes that were reasonably reproducible across studies and received prospective validation in at least one study.

Impact of tobacco-related chronic obstructive pulmonary disease on developmental trajectories of comorbidities in the Taiwan population

The presence of COPD may be considered a pathogenic factor involved in the development of certain comorbidities, and the incidence was remarkably higher for hypertension and malignancy as compared to non-COPD matched controls.

Influence of comorbidities in long-term survival of chronic obstructive pulmonary disease patients.

Increasing number of comorbidities in COPD patients with severe exacerbation were found to negatively affect long-term survival, and both the evaluation and treatment of comorebidities are considered to be important in the reduction of long- term mortality in patients with COPD.

Epidemiology and clinical impact of major comorbidities in patients with COPD

  • M. SmithJ. Wrobel
  • Medicine
    International journal of chronic obstructive pulmonary disease
  • 2014
This review will highlight the importance of comorbidity identification and management in the practice of caring for patients with COPD and emphasize the clinical impact upon prognosis and management considerations.

Identification of five chronic obstructive pulmonary disease subgroups with different prognoses in the ECLIPSE cohort using cluster analysis.

Cluster analysis using baseline data in ECLIPSE identified five COPD subgroups that differ in outcomes and inflammatory biomarkers and show different relationships between clinical parameters, suggesting the clusters represent clinically and biologically different subtypes of COPD.

Subtypes of Patients Experiencing Exacerbations of COPD and Associations with Outcomes

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.

COPD and its comorbidities: Impact, measurement and mechanisms

The concepts of comorbidity and multi‐morbidity in COPD in relation to the overall clinical outcome of COPD management are discussed and some of the currently available clinical scores used to measureComorbid conditions and their prognostic abilities are summarized.



Two Distinct Chronic Obstructive Pulmonary Disease (COPD) Phenotypes Are Associated with High Risk of Mortality

Three COPD phenotypes are identified, including two phenotypes with high risk of mortality, which may require different therapeutic interventions to improve their outcome.

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

A simple disease-specific comorbidities index (COTE) helps assess mortality risk in patients with COPD and increases in the BODE and COTE were independently associated with increased risk of death.

Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes

In patients with COPD recruited at their first hospitalisation, three different COPD subtypes were identified and prospectively validated: ‘severe respiratory COPD’, ‘moderate respiratory COPd’ and ‘systemic COPD'.

Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation

Most patients with COPD undergoing pulmonary rehabilitation have one or moreComorbidities, and the improvement in exercise tolerance and quality of life after rehabilitation may be reduced depending on the comorbidity.

Persistent Systemic Inflammation is Associated with Poor Clinical Outcomes in COPD: A Novel Phenotype

Overall, the results identify a novel systemic inflammatory COPD phenotype that may be the target of specific research and treatment and show associations but do not prove causality.

Patterns of comorbidities in newly diagnosed COPD and asthma in primary care.

COPD and asthma are conditions associated with many comorbidities, albeit asthma to a lesser extent than COPD, which had not been systematically reviewed before.

Systemic manifestations and comorbidities of COPD

Treatment of COPD inflammation may concomitantly treat systemic inflammation and associated comorbidities, however, new broad-spectrum anti-inflammatory treatments, such as phosphodiesterase 4 inhibitors, have significant side-effects so it may be necessary to develop inhaled drugs in the future.

Clinical COPD phenotypes: a novel approach using principal component and cluster analyses

Importantly, subjects with comparable airflow limitation (FEV1) belonged to different phenotypes and had marked differences in age, symptoms, comorbidities and predicted mortality, underscore the need for novel multidimensional COPD classification for improving patient care and quality of clinical trials.

Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD

Subjects with GOLD stage 3 or 4 COPD had a higher prevalence of diabetes, which contributes to a higher risk of adverse outcomes of mortality and hospitalisations, and subjects with impaired lung function had more comorbid disease.

Clinical COPD phenotypes identified by cluster analysis: validation with mortality

The usefulness of applying mathematical models to multiple variables for the identification of clinical phenotypes in a cohort of COPD subjects is reported, and a panel of experts proposed the following modified definition for clinical COPD phenotypes.