Avaliação dos fenótipos dos diferentes clusters em pacientes portadores de doença pulmonar obstrutiva crônica (DPOC) nos desfechos de exacerbação e mortalidade em dois anos
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Data
2022-08-24
Autores
Zucchi, José William [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A doença pulmonar obstrutiva crônica (DPOC) é uma doença altamente prevalente, complexa e heterogênea, caracterizada por sintomas respiratórios persistentes e limitação do fluxo aéreo devido a anormalidades das vias aéreas e/ou alveolares geralmente causada por exposição significativa a partículas ou gases nocivos. As manifestações pulmonares e extrapulmonares da DPOC, assim como a presença de outras doenças crônicas não transmissíveis, tornam-na uma doença com diferentes fenótipos clínicos. A estratificação de grupos específicos de pacientes com DPOC pode resultar na melhor conduta de tratamento, pois permite informações importantes sobre prognóstico, afim de prevenir os desfechos negativos da doença e redução nos custos para o tratamento. O objetivo do nosso estudo foi avaliar as taxas de exacerbação e mortalidade nos diferentes fenótipos em pacientes com DPOC no período de dois anos. Métodos: Este estudo envolveu 351 pacientes. Na linha de base, todos os pacientes realizaram o Índice de Charlson, índice de massa corporal, tratamento farmacológico atual, história de tabagismo (maço.ano), história de exacerbações/internações no último ano, espirometria, teste de caminhada de seis minutos, questionários de qualidade de vida, dispneia e escala hospitalar de ansiedade e depressão. Amostras de sangue também foram coletadas para dosagem de proteína C reativa, gasometria e hemograma. Os pacientes foram separados em quatro grupos previamente definidos, de acordo com as análises clínicas e laboratoriais e foram acompanhados por dois anos. Cluster 1 (n=203): DPOC leve; cluster 2 (n=49): eosinofílico; cluster 3 (n=13): inflamação sistêmica; e cluster 4 (n=26): obstrução grave. Todos os pacientes foram reavaliados para quantificação das taxas de exacerbações moderadas a graves e mortalidade a cada seis meses. Resultados: Após dois anos de seguimento, foram reavaliados os dados de 291 pacientes. As taxas de eventos de exacerbação nos clusters 1, 2, 3 e 4 foram 74, 17, 5 e 10, respectivamente (p=0,54). A taxa de mortalidade foi maior nos clusters 3 e 4 (46%), seguidos pelos clusters 2 (20%) e 1 (16%). As mortes cardiovasculares foram maiores nos clusters 1 (42,5%) e 2 (70%), e as complicações pulmonares foram maiores nos clusters 3 (66,7%) e 4 (75%). O risco proporcional de Cox (HR) identificou que o cluster 4 apresentou um aumento estatisticamente significativo de HR=3,49 (95%CI:1,73-7,05) e o cluster 3 e HR=3,07 (95% CI: 1,27-7,45) em comparação com o cluster 1. Conclusão: A DPOC é uma doença heterogênea que se desenvolve em diferentes fenótipos e características clínicas. Identificamos os diferentes componentes que podem ser adicionados como meta do tratamento da DPOC em cada cluster, o que pode modificar o risco de exacerbações e mortalidade.
Chronic obstructive pulmonary disease (COPD) is a highly prevalent, complex and heterogeneous disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. The pulmonary and extrapulmonary manifestations of COPD, as well as the presence of other chronic non-communicable diseases, make it a disease with different clinical phenotypes. The stratification of specific groups of COPD patients can result in the best treatment approach, as it allows important information on prognosis, in order to prevent negative outcomes of the disease and reduce treatment costs. The aim of our study was to assess exacerbation and mortality rates in different phenotypes in COPD patients over a two-year period. Methods: This study involved 351 patients. At baseline, all patients performed the Charlson Index, body mass index, current pharmacological treatment, smoking history (pack.year), history of exacerbations/hospitalizations in the last year, spirometry, sixminute walk test, questionnaires on quality of life, dyspnea and hospital anxiety and depression scale. Blood samples were also collected for C-reactive protein dosage, blood gas analysis and blood count. Patients were separated into four previously defined groups, according to clinical and laboratory analysis, and were followed up for two years. Cluster 1 (n=203): mild COPD; cluster 2 (n=49): eosinophilic; cluster 3 (n=13): systemic inflammation; and cluster 4 (n=26): severe obstruction. All patients were reassessed for quantification of moderate to severe exacerbation and mortality rates every six months. Results: After two years of follow-up, data from 291 patients were reassessed. The exacerbation event rates in clusters 1, 2, 3 and 4 were 74, 17, 5 and 10, respectively (p=0.54). The mortality rate was higher in clusters 3 and 4 (46%), followed by clusters 2 (20%) and 1 (16%). Cardiovascular deaths were higher in clusters 1 (42.5%) and 2 (70%), and pulmonary complications were higher in clusters 3 (66.7%) and 4 (75%). Cox proportional hazards (HR) identified that cluster 4 showed a statistically significant increase of HR=3.49 (95%CI:1.73-7.05) and cluster 3 and HR=3.07 (95% CI: 1.27-7.45) compared to cluster 1. Conclusion: COPD is a heterogeneous disease that develops in different phenotypes and clinical features. We identified the different components that can be added as a COPD treatment goal in each cluster, which can modify the risk of exacerbations and mortality.
Chronic obstructive pulmonary disease (COPD) is a highly prevalent, complex and heterogeneous disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. The pulmonary and extrapulmonary manifestations of COPD, as well as the presence of other chronic non-communicable diseases, make it a disease with different clinical phenotypes. The stratification of specific groups of COPD patients can result in the best treatment approach, as it allows important information on prognosis, in order to prevent negative outcomes of the disease and reduce treatment costs. The aim of our study was to assess exacerbation and mortality rates in different phenotypes in COPD patients over a two-year period. Methods: This study involved 351 patients. At baseline, all patients performed the Charlson Index, body mass index, current pharmacological treatment, smoking history (pack.year), history of exacerbations/hospitalizations in the last year, spirometry, sixminute walk test, questionnaires on quality of life, dyspnea and hospital anxiety and depression scale. Blood samples were also collected for C-reactive protein dosage, blood gas analysis and blood count. Patients were separated into four previously defined groups, according to clinical and laboratory analysis, and were followed up for two years. Cluster 1 (n=203): mild COPD; cluster 2 (n=49): eosinophilic; cluster 3 (n=13): systemic inflammation; and cluster 4 (n=26): severe obstruction. All patients were reassessed for quantification of moderate to severe exacerbation and mortality rates every six months. Results: After two years of follow-up, data from 291 patients were reassessed. The exacerbation event rates in clusters 1, 2, 3 and 4 were 74, 17, 5 and 10, respectively (p=0.54). The mortality rate was higher in clusters 3 and 4 (46%), followed by clusters 2 (20%) and 1 (16%). Cardiovascular deaths were higher in clusters 1 (42.5%) and 2 (70%), and pulmonary complications were higher in clusters 3 (66.7%) and 4 (75%). Cox proportional hazards (HR) identified that cluster 4 showed a statistically significant increase of HR=3.49 (95%CI:1.73-7.05) and cluster 3 and HR=3.07 (95% CI: 1.27-7.45) compared to cluster 1. Conclusion: COPD is a heterogeneous disease that develops in different phenotypes and clinical features. We identified the different components that can be added as a COPD treatment goal in each cluster, which can modify the risk of exacerbations and mortality.
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Palavras-chave
Fenótipos da DPOC, Análise de clusters, Mortalidade, Função pulmonar, Exacerbação, COPD phenotypes, Cluster analysis, Mortality, Lung function, Exacerbation