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Long-term outcomes following first short-term clinically important deterioration in COPD
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by varying trajectories of decline. Information regarding the prognostic value of preventing short-term clinically important deterioration (CID) in lung function, health status, or first moderate/severe exacerbation as a compo...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245880/ https://www.ncbi.nlm.nih.gov/pubmed/30453972 http://dx.doi.org/10.1186/s12931-018-0928-3 |
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author | Naya, Ian P. Tombs, Lee Muellerova, Hana Compton, Christopher Jones, Paul W. |
author_facet | Naya, Ian P. Tombs, Lee Muellerova, Hana Compton, Christopher Jones, Paul W. |
author_sort | Naya, Ian P. |
collection | PubMed |
description | BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by varying trajectories of decline. Information regarding the prognostic value of preventing short-term clinically important deterioration (CID) in lung function, health status, or first moderate/severe exacerbation as a composite endpoint of worsening is needed. We evaluated post hoc the link between early CID and long-term adverse outcomes. METHODS: CID was defined as ≥100 mL decrease in forced expiratory volume in 1 s (FEV(1)), ≥4-unit increase in St George’s Respiratory Questionnaire (SGRQ) score from baseline, and/or a moderate/severe exacerbation during enrollment in two 3-year studies. Presence of CID was assessed at 6 months for the principal analysis (TORCH) and 12 months for the confirmatory analysis (ECLIPSE). Association between presence (+) or absence (-) of CID and long-term deterioration in FEV(1), SGRQ, future risk of exacerbations, and all-cause mortality was assessed. RESULTS: In total, 2870 (54%; TORCH) and 1442 (73%; ECLIPSE) patients were CID+. At 36 months, in TORCH, CID+ patients (vs CID-) had sustained clinically significant worsening of FEV(1) (- 117 mL; 95% confidence interval [CI]: - 134, - 100 mL; P < 0.001) and SGRQ score (+ 6.42 units; 95% CI: 5.40, 7.45; P < 0.001), and had higher risk of exacerbations (hazard ratio [HR]: 1.61 [95% CI: 1.50, 1.72]; P < 0.001) and all-cause mortality (HR: 1.41 [95% CI: 1.15, 1.72]; P < 0.001). Similar risks post-CID were observed in ECLIPSE. CONCLUSIONS: A CID within 6–12 months of follow-up was consistently associated with increased long-term risk of exacerbations and all-cause mortality, and predicted sustained meaningful loss in FEV(1) and health status amongst survivors. TRIAL REGISTRATION: NCT00268216; NCT00292552. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12931-018-0928-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6245880 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62458802018-11-26 Long-term outcomes following first short-term clinically important deterioration in COPD Naya, Ian P. Tombs, Lee Muellerova, Hana Compton, Christopher Jones, Paul W. Respir Res Research BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by varying trajectories of decline. Information regarding the prognostic value of preventing short-term clinically important deterioration (CID) in lung function, health status, or first moderate/severe exacerbation as a composite endpoint of worsening is needed. We evaluated post hoc the link between early CID and long-term adverse outcomes. METHODS: CID was defined as ≥100 mL decrease in forced expiratory volume in 1 s (FEV(1)), ≥4-unit increase in St George’s Respiratory Questionnaire (SGRQ) score from baseline, and/or a moderate/severe exacerbation during enrollment in two 3-year studies. Presence of CID was assessed at 6 months for the principal analysis (TORCH) and 12 months for the confirmatory analysis (ECLIPSE). Association between presence (+) or absence (-) of CID and long-term deterioration in FEV(1), SGRQ, future risk of exacerbations, and all-cause mortality was assessed. RESULTS: In total, 2870 (54%; TORCH) and 1442 (73%; ECLIPSE) patients were CID+. At 36 months, in TORCH, CID+ patients (vs CID-) had sustained clinically significant worsening of FEV(1) (- 117 mL; 95% confidence interval [CI]: - 134, - 100 mL; P < 0.001) and SGRQ score (+ 6.42 units; 95% CI: 5.40, 7.45; P < 0.001), and had higher risk of exacerbations (hazard ratio [HR]: 1.61 [95% CI: 1.50, 1.72]; P < 0.001) and all-cause mortality (HR: 1.41 [95% CI: 1.15, 1.72]; P < 0.001). Similar risks post-CID were observed in ECLIPSE. CONCLUSIONS: A CID within 6–12 months of follow-up was consistently associated with increased long-term risk of exacerbations and all-cause mortality, and predicted sustained meaningful loss in FEV(1) and health status amongst survivors. TRIAL REGISTRATION: NCT00268216; NCT00292552. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12931-018-0928-3) contains supplementary material, which is available to authorized users. BioMed Central 2018-11-20 2018 /pmc/articles/PMC6245880/ /pubmed/30453972 http://dx.doi.org/10.1186/s12931-018-0928-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Naya, Ian P. Tombs, Lee Muellerova, Hana Compton, Christopher Jones, Paul W. Long-term outcomes following first short-term clinically important deterioration in COPD |
title | Long-term outcomes following first short-term clinically important deterioration in COPD |
title_full | Long-term outcomes following first short-term clinically important deterioration in COPD |
title_fullStr | Long-term outcomes following first short-term clinically important deterioration in COPD |
title_full_unstemmed | Long-term outcomes following first short-term clinically important deterioration in COPD |
title_short | Long-term outcomes following first short-term clinically important deterioration in COPD |
title_sort | long-term outcomes following first short-term clinically important deterioration in copd |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245880/ https://www.ncbi.nlm.nih.gov/pubmed/30453972 http://dx.doi.org/10.1186/s12931-018-0928-3 |
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