Journal Article

Prediction of first acute exacerbation using COPD subtypes identified by cluster analysis

Lee, Jin Hwa, Lee, Jae Seung, Lee, Chang Hoon, Yoo, Kwang Ha, Byun, Min-Kwang, Lee, Won-Yeon, Yoon, Hee-Young, Park, So Young, Jung, Ki-Suck

2019

Overview

In patients with COPD, acute exacerbation (AE) is not only an important determinant of prognosis, but also an important factor in choosing therapeutic agents. In this study, we evaluated the usefulness of COPD subtypes identified through cluster analysis to predict the first AE. Among COPD patients in the Korea COPD Subgroup Study (KOCOSS) cohort, 1,195 who had follow-up data for AE were included in our study. We selected seven variables for cluster analysis - age, body mass index, smoking status, history of asthma, COPD assessment test (CAT) score, post-bronchodilator (BD) FEV % predicted, and diffusing capacity of carbon monoxide % predicted. K-means clustering identified four clusters for COPD that we named putative asthma-COPD overlap (ACO), mild COPD, moderate COPD, and severe COPD subtypes. The ACO group (n=196) showed the second-best post-BD FEV (75.5% vs 80.9% [mild COPD, n=313] vs 52.4% [moderate COPD, n=345] vs 46.7% [severe COPD, n=341] predicted), the longest 6-min walking distance (424 m vs 405 m vs 389  m vs 365 m), and the lowest CAT score (12.2 vs 13.7 vs 15.6 vs 17.5) among the four groups. ACO group had greater risk for first AE compared to the mild COPD group (HR, 1.683; 95% CI, 1.175-2.410). The moderate COPD and severe COPD group HR values were 1.587 (95% CI, 1.145-2.200) and 1.664 (95% CI, 1.203-2.302), respectively. In addition, St. George's Respiratory Questionnaire score (HR: 1.019; 95% CI, 1.014-1.024) and gastroesophageal reflux disease were independent factors associated with the first AE (HR: 1.535; 95% CI, 1.116-2.112). Our cluster analysis revealed an exacerbator subtype of COPD independent of FEV . Since these patients are susceptible to AE, a more aggressive treatment strategy is needed in these patients.

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• Subject: 1 Chang Hoon Lee / 1 So Young Park / 1.014-1.024) and gastroesophageal reflux disease were independent factors associated with the first AE (HR: 1.535; 95% CI / 1.116-2.112). clustering / 1.145-2.200) and 1.664 (95% CI / 1.175-2.410). The moderate COPD and severe COPD group HR values were 1.587 (95% CI / 1.203-2.302 / 1.683; 95% CI / 195 who had follow-up data for AE were included in our study. We selected seven variables for cluster analysis - age / 2 Min-Kwang Byun / 3 Joo Ock Na / 4 Jae Seung Lee / 5 Won-Yeon Lee / 6 Kwang Ha Yoo / 7 Ki-Suck Jung / 8 Jin Hwa Lee11Division of Pulmonary and Critical Care Medicine / acute exacerbation (AE) is not only an important determinant of prognosis / Age Factors / Airway management / Allergy and Critical Care Medicine / and diffusing capacity of carbon monoxide % predicted. Results: K-means clustering identified four clusters for COPD that we named putative asthma-COPD overlap (ACO) / and severe COPD subtypes. The ACO group (n=196) showed the second-best post-BD FEV1 (75.5% vs 80.9% [mild COPD / and the lowest CAT score (12.2 vs 13.7 vs 15.6 vs 17.5) among the four groups. ACO group had greater risk for first AE compared to the mild COPD group (HR / Anyang / Asan Medical Centre / Asthma / Asthma - diagnosis / Asthma - epidemiology / Asthma - physiopathology / asthma-COPD overlap / Body Mass Index / Bronchodilator Agents - therapeutic use / but also an important factor in choosing therapeutic agents. In this study / Carbon monoxide / Cheonan / Chronic obstructive lung disease / Cluster Analysis / Clustering / College of Medicine / Comorbidity / COPD assessment test (CAT) score / Demographics / Department of Internal Medicine / Disease Progression / Ewha Womans Seoul Hospital / Ewha Womans University / Exacerbation / Forced Expiratory Volume / Gangnam Severance Hospital / Gastroesophageal reflux / Hallym University College of Medicine / Hallym University Medical Center / Hee-Young Yoon / history of asthma / Humans / Konkuk University College of Medicine / Korea; 2Division of Pulmonary and Critical Care Medicine / Korea; 3Division of Pulmonary Medicine / Korea; 4Division of Pulmonology / Korea; 5Department of Pulmonary and Critical Care Medicine / Korea; 6Department of Internal Medicine / Korea; 7Department of Internal Medicine / Korea; 8Division of Pulmonary / KoreaPurpose: In patients with COPD / Laboratories / Lung - drug effects / Lung - physiopathology / Medical prognosis / Medical research / mild COPD / moderate COPD / Multivariate analysis / n=313] vs 52.4% [moderate COPD / n=341] predicted / n=345] vs 46.7% [severe COPD / Original Research / Patients / Phenotype / post-bronchodilator (BD) FEV1 % predicted / Predictive Value of Tests / Prognosis / Pulmonary Diffusing Capacity / Pulmonary Disease, Chronic Obstructive - diagnosis / Pulmonary Disease, Chronic Obstructive - drug therapy / Pulmonary Disease, Chronic Obstructive - epidemiology / Pulmonary Disease, Chronic Obstructive - physiopathology / Republic of Korea - epidemiology / respectively. In addition / Retrospective Studies / Risk Assessment / Risk Factors / Roflumilast / Seoul / Seoul National University Hospital / Smoking - adverse effects / Smoking - epidemiology / Smoking - physiopathology / smoking status / Soonchunhyang University / St. George's Respiratory Questionnaire score (HR: 1.019; 95% CI / the longest 6-min walking distance (424 m vs 405 m vs 389 m vs 365 m) / Time Factors / University of Ulsan College of Medicine / we evaluated the usefulness of COPD subtypes identified through cluster analysis to predict the first AE. Patients and methods: Among COPD patients in the Korea COPD Subgroup Study (KOCOSS) cohort / Wonju / Wonju Christian Hospital / Yonsei University College of Medicine / Yonsei University Health System / Yonsei University Wonju College of Medicine