Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort

• Published in: Respiratory medicine 2013-09, Vol.107 (9), p.1376-1384
• Main Authors: Miller, Joy, Edwards, Lisa D, Agustí, Alvar, Bakke, Per, Calverley, Peter M.A, Celli, Bartolome, Coxson, Harvey O, Crim, Courtney, Lomas, David A, Miller, Bruce E, Rennard, Steve, Silverman, Edwin K, Tal-Singer, Ruth, Vestbo, Jørgen, Wouters, Emiel, Yates, Julie C, MacNee, William
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood; Cardiovascular disease; Chronic obstructive pulmonary disease; Cigarette smoking; Comorbidity; Confidence intervals; Diabetes; Diabetes Complications - mortality; Drug therapy; Emphysema; Female; Heart Diseases - mortality; Humans; Hypertension - mortality; Inflammation - mortality; Longitudinal Studies; Lung diseases; Male; Middle Aged; Osteoporosis; Osteoporosis - mortality; Prognosis; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Emphysema - mortality; Pulmonary/Respiratory; Questionnaires; Smoking - mortality
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2013.05.001

Summary Comorbidities, are common in COPD, have been associated with poor outcomes and are thought to relate to systemic inflammation. To investigate comorbidities in relation to systemic inflammation and outcomes we recorded comorbidities in a well characterized cohort (ECLIPSE study) for 2164 clinically stable COPD subjects, 337 smokers and 245 non-smokers with normal lung function. COPD patients had a higher prevalence of osteoporosis, anxiety/panic attacks, heart trouble, heart attack, and heart failure, than smokers or nonsmokers. Heart failure (Hazard Ratio [HR] 1.9, 95% Confidence Interval [CI] 1.3–2.9), ischemic heart disease (HR 1.5, 95% CI 1.1–2.0), heart disease (HR 1.5, 95% CI 1.2–2.0), and diabetes (HR 1.7, 95% CI 1.2–2.4) had increased odds of mortality when coexistent with COPD. Multiple comorbidities had accumulative effect on mortality. COPD and cardiovascular disease was associated with poorer quality of life, higher MRC dyspnea scores, reduced 6MWD, higher BODE index scores. Osteoporosis, hypertension and diabetes were associated with higher MRC dyspnea scores and reduced 6MWD. Higher blood concentrations of fibrinogen, IL-6 and IL-8 levels occurred in those with heart disease. Comorbidity is associated with poor clinical outcomes in COPD. The comorbidities of heart disease, hypertension and diabetes are associated with increased systemic inflammation.