Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients

• Published in: PloS one 2015-08, Vol.10 (8), p.e0135116-e0135116
• Main Authors: Pandolfi, Paolo, Zanasi, Alessandro, Musti, Muriel Assunta, Stivanello, Elisa, Pisani, Lara, Angelini, Sabrina, Maffei, Francesca, Hrelia, Silvana, Angeloni, Cristina, Zenesini, Corrado, Hrelia, Patrizia
• Format: Article
• Language: English
• Subjects: Age; Aged; Anthropometry; Body composition; Body mass; Body mass index; Body size; Body Weight; Care and treatment; Chronic illnesses; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Comorbidity; Demographics; Development and progression; Disease Progression; Economic aspects; Environmental factors; Exercise; Female; Fragility; Health aspects; Health risks; Hospitalization; Hospitals; Humans; Kaplan-Meier Estimate; Life Style; Lifestyles; Lung diseases; Male; Medical prognosis; Middle Aged; Mortality; Obstructive lung disease; Patient outcomes; Patients; Pharmacy; Proportional Hazards Models; Public health; Pulmonary Disease, Chronic Obstructive - economics; Pulmonary Disease, Chronic Obstructive - epidemiology; Quality of life; Respiratory function; Risk analysis; Risk Factors; Severity of Illness Index; Smoking; Social Class; Sociodemographics; Socioeconomic factors; Socioeconomics; Spirometry; Studies; Thorax; Underweight
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0135116

Socio-economic, cultural and environmental factors are becoming increasingly important determinants of chronic obstructive pulmonary disease (COPD). We conducted a study to investigate socio-demographic, lifestyle and clinical factors, and to assess their role as predictors of acute events (mortality or hospitalization for respiratory causes) in a group of COPD patients. Subjects were recruited among outpatients who were undertaking respiratory function tests at the Pneumology Unit of the Sant'Orsola-Malpighi Hospital, Bologna. Patients were classified according to the GOLD Guidelines. 229 patients with COPD were included in the study, 44 with Mild, 68 Moderate, 52 Severe and 65 Very Severe COPD (GOLD stage). Significant differences among COPD stage, in terms of smoking status and fragility index, were detected. COPD stage significantly affected the values of all clinical tests (spirometry and ABG analysis). Kaplan-Meier estimates showed a significant difference between survival curves by COPD stage with lower event-free probability in very severe COPD stage. Significant risk factors for acute events were: underweight (HR = 4.08; 95% CI 1.01-16.54), having two or more comorbidities (HR = 4.71; 95% CI 2.52-8.83), belonging to moderate (HR = 3.50; 95% CI 1.01-12.18) or very severe COPD stage (HR = 8.23; 95% CI 2.35-28.85). Our findings indicate that fragility is associated with COPD stage and that comorbidities and the low body mass index are predictors of mortality or hospitalization. Besides spirometric analyses, FeNO measure and comorbidities, body mass index could also be considered in the management and monitoring of COPD patients.