Finding the best thresholds of FEV1and dyspnea to predict 5-year survival in COPD patients: The COCOMICS study

Almagro, P. ; Martinez-Camblor, P. ; Soriano, J. B. ; Marin, J. M. (Universidad de Zaragoza) ; Alfageme, I. ; Casanova, C. ; Esteban, C. ; Soler-Cataluña, J. J. ; De-Torres, J. ; Celli, B. R. ; Miravitlles, M.

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

Financiación: info:eu-repo/grantAgreement/ES/MICINN/MTM2011-23204

Tipo y forma: Article (Published version)

Área (Departamento): Medicina (Departamento de Medicina, Psiquiatría y Dermatología)