Incidencia de exacerbación grave en pacientes codiagnosticados de diabetes y enfermedad pulmonar obstructiva crónica: estudio de cohorte

OBJECTIVE: To estimate the incidence of hospitalizations for severe exacerbation of chronic obstructive pulmonary disease (COPD) and its associated factors in a cohort of patients diagnosed with COPD and diabetes type 2. DESIGN: Prospective cohort study. SITE: Primary care centres of Lleida city (7 centres totally). PARTICIPANTS: Based on a sample of 716 patients diagnosed by COPD and diabetes. The inclusion criteria was carried out by patients of both genders, equal to or older than 40 years, ordinarily residents in the geographical area of Lleida city, with the diagnosis of COPD according to GOLD guideline, with recent spirometry and FEV(1)/FVC ratio <0.7; diagnosed with diabetes type 2 according to the guidelines of the International Diabetes Federation. The exclusion criteria were suffering from a serious physical or mental illness. MAIN MEASUREMENTS: The study variables were comprised by gender, age, primary care centre of Lleida, body mass index, waist circumference, smoking and enolic habit, blood pressure, heart failure, chronic renal failure, FEV(1), FEV(1)/FVC, GOLD categorization, glycosylated haemoglobin (HbA1c). There were registered by influenza and pneumococcal vaccine. The dependent variable was severe exacerbation. In statistical analysis, the association of the dependent variable with the independent variables was determined by calculating the Hazard ratio (HR) with the 95% confidence interval. HR was estimated in an adjusted way by using unconditional Cox regression model. RESULTS: The incidence for severe exacerbation of COPD was 9.98%; that means that an increased risk of severe exacerbation was registered in patients diagnosed with heart failure (HR = 2.27; p = .002), and with lower FEV(1)/FVC ratio. The influenza and pneumococcal vaccines provided weak protection to prevent exacerbations, however it was not statistically significant. CONCLUSION: It documents a significant incidence of exacerbation in patients diagnosed with DM2 and COPD. Heart failure and a lower FEV(1)/FVC could increase the exacerbation risk.