Finding the best thresholds of FEV1and dyspnea to predict 5-year survival in COPD patients: The COCOMICS study
Resumen: 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.
Idioma: Inglés
DOI: 10.1371/journal.pone.0089866
Año: 2014
Publicado en: PLoS One 9, 2 (2014), e89866 [7 pp]
ISSN: 1932-6203

Factor impacto JCR: 3.234 (2014)
Categ. JCR: MULTIDISCIPLINARY SCIENCES rank: 9 / 57 = 0.158 (2014) - Q1 - T1
Factor impacto SCIMAGO:

Financiación: info:eu-repo/grantAgreement/ES/MICINN/MTM2011-23204
Tipo y forma: Article (Published version)
Área (Departamento): Medicina (Departamento de Medicina, Psiquiatría y Dermatología)

Creative Commons You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.


Exportado de SIDERAL (2017-11-28-13:52:01)

Este artículo se encuentra en las siguientes colecciones:
Articles > Artículos por área > Medicina



 Record created 2017-11-28, last modified 2017-11-29


Versión publicada:
 PDF
Rate this document:

Rate this document:
1
2
3
 
(Not yet reviewed)