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Original article
One-year change in health status and subsequent outcomes in COPD
  1. Sarah Wilke1,
  2. Paul W Jones2,
  3. H Müllerova3,
  4. Jørgen Vestbo4,5,
  5. Ruth Tal-Singer6,
  6. Frits ME Franssen1,
  7. Alvar Agusti7,
  8. Per Bakke8,
  9. Peter M Calverley9,
  10. Harvey O Coxson10,
  11. Courtney Crim11,
  12. Lisa D Edwards11,
  13. David A Lomas12,
  14. William MacNee13,
  15. Stephen I Rennard14,
  16. Julie C Yates11,
  17. Emiel FM Wouters1,15,
  18. Martijn A Spruit1,16
  1. 1Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
  2. 2Division of Clinical Science, St George's University of London, London, UK
  3. 3Respiratory Epidemiology, GlaxoSmithKline, Uxbridge, UK
  4. 4Department of Respiratory Medicine, Gentofte Hospital Hellerup, Gentofte, Denmark
  5. 5Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation, Manchester, UK
  6. 6Research and Development, GlaxoSmithKline, King of Prussia, UK
  7. 7Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona and CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
  8. 8Department of Thoracic Medicine, Institute of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway
  9. 9Division of Infection and Immunity Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
  10. 10Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
  11. 11GlaxoSmithKline, Research Triangle Park, North Carolina, USA
  12. 12Wolfson Institute for Biomedical Research, University College London, London, UK
  13. 13MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edingburgh, UK
  14. 14Division of Pulmonary, Critical Care, Sleep & Allergy, University of Nebraska Medical Center, Omaha, USA
  15. 15Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  16. 16Faculty of Medicine and Life Sciences, REVAL—Rehabilitation Research Center, BIOMED—Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
  1. Correspondence to Sarah Wilke, Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Hornerheide 1, NM Horn 6085, The Netherlands; sarahwilke{at}ciro-horn.nl

Abstract

Background Poor health status has been associated with morbidity and mortality in patients with COPD. To date, the impact of changes in health status on these outcomes remains unknown.

Aims To explore the relationship of clinically relevant changes in health status with exacerbation, hospitalisation or death in patients with COPD.

Methods Characteristics and health status (St George's Respiratory Questionnaire, SGRQ) were assessed over a period of 3 years in 2138 patients with COPD enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study: a longitudinal, prospective, observational study. Associations between change in health status (=4 units in SGRQ score) during year 1 and time to first exacerbation, hospitalisation and death during 2-year follow-up were assessed using Kaplan–Meier plots and log-rank test.

Results 1832 (85.7%) patients (age 63.4±7.0 years, 65.4% male, FEV1 48.7±15.6% predicted) underwent assessment at baseline and 1 year. Compared with those who deteriorated, patients with improved or stable health status in year 1 have a lower likelihood of exacerbation (HR 0.78 (95% CI 0.67 to 0.89), p<0.001 and 0.84 (0.73 to 0.97), p=0.016, respectively), hospitalisation (0.72 (0.58 to 0.90), p=0.004 and 0.77 (0.62 to 0.96), p=0.023, respectively) or dying (0.61 (0.39 to 0.95), p=0.027 and 0.58 (0.37 to 0.92), p=0.019, respectively) during 2-year follow-up. This effect persisted after stratification for age and the number of exacerbations and hospitalisations during the first year of the study.

Conclusions Patients with stable or improved health status during year 1 of ECLIPSE had a lower likelihood of exacerbation, hospitalisation or dying during 2-year follow-up. Interventions that stabilise and improve health status may also improve outcomes in patients with COPD.

Trial registration number NCT00292552, registered at ClinicalTrials.gov.

  • COPD Exacerbations

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