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Subtypes of patients experiencing exacerbations of COPD and associations with outcomes.

Arostegui I, Esteban C, García-Gutierrez S, Bare M, Fernández-de-Larrea N, Briones E, Quintana JM, IRYSS-COPD Gro - PLoS ONE (2014)

Bottom Line: Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit.Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B.These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Matemática Aplicada y Estadística e I. O, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain.

ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.

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Related in: MedlinePlus

Partial dendrogram obtained from the cluster analysis.Full legend: The dendogram represents the results from the cluster analysis performed with the three components obtained from the multiple correspondence analysis. The graphical display includes an easy interpretation of the partition and a brief description of the resulting groups.
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pone-0098580-g003: Partial dendrogram obtained from the cluster analysis.Full legend: The dendogram represents the results from the cluster analysis performed with the three components obtained from the multiple correspondence analysis. The graphical display includes an easy interpretation of the partition and a brief description of the resulting groups.

Mentions: After applying CA to these results, four subtypes of ECOPD patient were identified (Figure 3). Type A had the least severe ECOPD, type D the most severe. Subjects are represented in Figure 2 using different colors for these four subtypes.


Subtypes of patients experiencing exacerbations of COPD and associations with outcomes.

Arostegui I, Esteban C, García-Gutierrez S, Bare M, Fernández-de-Larrea N, Briones E, Quintana JM, IRYSS-COPD Gro - PLoS ONE (2014)

Partial dendrogram obtained from the cluster analysis.Full legend: The dendogram represents the results from the cluster analysis performed with the three components obtained from the multiple correspondence analysis. The graphical display includes an easy interpretation of the partition and a brief description of the resulting groups.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4044022&req=5

pone-0098580-g003: Partial dendrogram obtained from the cluster analysis.Full legend: The dendogram represents the results from the cluster analysis performed with the three components obtained from the multiple correspondence analysis. The graphical display includes an easy interpretation of the partition and a brief description of the resulting groups.
Mentions: After applying CA to these results, four subtypes of ECOPD patient were identified (Figure 3). Type A had the least severe ECOPD, type D the most severe. Subjects are represented in Figure 2 using different colors for these four subtypes.

Bottom Line: Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit.Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B.These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Matemática Aplicada y Estadística e I. O, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain.

ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.

Show MeSH
Related in: MedlinePlus