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[Prognostic markers of COPD. Role of comorbidity].
Abstract
A chronic disease such as chronic obstructive pulmonary disease (COPD) will inevitably have biological markers influencing its natural history or progression. The most extensively studied marker is forced expiratory volume in 1 second (FEV(1)), classically recognized as the best prognostic indicator of the disease. Other physiopathological variables are also known to have prognostic value. The course of COPD shows several distinct patterns but data are lacking on the natural history of this disease and the ability to predict which patients will show greater or lesser progression. In addition to FEV(1), there are other physiological markers of disease progression, such as gas interchange, air trapping, and pulmonary hypertension. The present article reviews the characteristics of all these markers, as well as those of two other categories: clinical markers, such as nutritional status, exercise capacity, the BODE index, which combines four physiopathological and clinical parameters, and the occurrence or absence of frequent exacerbations. Finally, a group of biological markers, potentially implicated in COPD, such as C-reactive protein, oxidative stress and other variables affecting changes in skeletal muscle, are described. COPD also predisposes affected individuals to the presence of other associated diseases or comorbidities, which can occur more frequently because of the presence of COPD itself and can potentially influence the outcome of this disease.
Copyright © 2009 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.
... 5 In another study, Krüger et al. indicated that 10% of diabetic patients were diagnosed with COPD. 2 Type 2 diabetes comorbidity is common in patients with COPD, increasing the total costs associated with this condition, because patients with COPD and Type 2 diabetes usually require more specialized care and medical tests. [6][7][8] Moreover, since it correlates with a longer hospital stay and a higher risk of infection, hyperglycaemia during hospital admission has been associated with bad prognosis. 9 One of the most frequent causes of hospital admission in patients with COPD are exacerbations. ...
Background:
Type 2 diabetes comorbidity is common in patients with COPD. One of the most frequent causes of hospital admission in patients with COPD are exacerbations.
Methods:
Prospective cohort study, which included 512 patients with COPD recruited in a primary care centre in Mollerussa (Lleida, Spain). Inclusion criteria were: patients >40 years of age with COPD according to the Global Initiative for Chronic Obstructive Lung Disease. Variables collected were as follows: age, gender, civil status, education level, smoking habit, severity (Global Initiative for Chronic Obstructive Lung Disease), comorbidities (Charlson), history of severe exacerbations, dyspnoea (mMRC), BODEx, EuroQol 5 D and depression (HAD). Logistic regression was used to determine the association of diabetes with risk of hospital admission and death.
Results:
Prevalence of diabetes was 25.8%. During the second year of follow up, 18.2% of patients with COPD and diabetes were admitted for exacerbation, in comparison with 8.9% non-diabetic COPD patients. The variables associated with hospital admission were diabetes (ORa=1.54); gender (men, ORa=1.93); age (ORa=1.02); number of hospital admissions during the previous year: 1 (ORa=2.83) or more than one admission (ORa=4.08); EuroQol 5 D (ORa=0.76) and BODEx (ORa=1.24). With the exclusion of BODEx, all these variables were associated with a higher risk of death.
Conclusion:
Prevalence of diabetes is high in patients suffering from COPD. COPD patients with diabetes are at higher risk of severe exacerbation and death. The suggested predictive model could identify patients at higher risk so that adequate preventive and therapeutic measures can be implemented.
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