Finding the best thresholds of FEV1 and dyspnea to predict 5-year survival in COPD patients: the COCOMICS study

BACKGROUND: FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence. OBJECTIVES: We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients. DESIGN AND METHODS: We cond...

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Detalles Bibliográficos
Autores: Almagro, P. (Pere)|||/items/c971cc1e-0746-43b6-9e1a-4fdd68f043b9, Martinez-Camblor, P. (Pablo)|||/items/1f28b5f6-4801-4f8b-a1fe-576aa1a0a3c3, Soriano, J.B. (Joan B.)|||/items/ba72f29a-0e75-4de6-849a-1987fe9ba393, Marin, J.M. (José M.)|||/items/ba27c460-2bb5-4f0a-ad2d-d02950b3ca4c, Alfageme, I. (Inmaculada)|||/items/0616ecf5-9b1b-4c04-8ff1-cc9ace182beb, Casanova, C. (Ciro)|||/items/535d45c8-67ad-48b7-8da7-52ba1ab9b0fc, Esteban, C. (Cristóbal)|||/items/95478616-24cd-4fe8-afcf-56bc8c38376d, Soler-Cataluña, J.J. (Juan José)|||/items/a15cfc9e-6a1d-4f3f-9d50-4336b4d77a4e, Torres-Tajes, J.P. (Juan Pablo) de|||/items/b7010baa-6964-4f25-a3e0-7e5586fb3f4c, Celli, B.R. (Bartolomé R.)|||/items/0f3745ce-e66d-4659-84da-e04d217d9d8f, Miravitlles, M. (Marc)|||/items/a2da5f77-4dab-41a1-a375-2bd33d8a52ed
Tipo de recurso: artículo
Fecha de publicación:2014
País:España
Institución:Universidad de Navarra
Repositorio:Dadun. Depósito Académico Digital de la Universidad de Navarra
Idioma:inglés
OAI Identifier:oai:dadun.unav.edu:10171/36408
Acceso en línea:https://hdl.handle.net/10171/36408
Access Level:acceso abierto
Palabra clave:FEV1
Dyspnea
COPD
Human
Survival
Neurología
Descripción
Sumario:BACKGROUND: FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence. OBJECTIVES: We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients. DESIGN AND METHODS: We conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival. RESULTS: A total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.4 ± 9.7, and predicted FEV1 of 53.8% (± 19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild ≥ 70%, moderate 56-69%, severe 36-55%, and very severe ≤ 35%. Survival at 5 years was 0.89 for patients with FEV1 ≥ 70 vs. 0.46 in patients with FEV1 ≤ 35% (H.R: 6; 95% C.I.: 4.69-7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear. CONCLUSIONS: The best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by ≥ 70%, 56-69%, 36-55%, and ≤ 35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs.

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