Identifier to cite or link to this item: http://hdl.handle.net/20.500.13003/12678
Finding the Best Thresholds of FEV1 and Dyspnea to Predict 5-Year Survival in COPD Patients: The COCOMICS Study
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ISSN: 1932-6203
WOS ID: 000332390800050
Scopus EID: 2-s2.0-84896105759
PMID: 24587085
Embase PUI: L372609729
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2014-02-27Document type
research articleCitation
Almagro P, Martinez-Camblor P, Soriano JB, Marin JM, Alfageme I, Casanova C, et al. Finding the Best Thresholds of FEV1 and Dyspnea to Predict 5-Year Survival in COPD Patients: The COCOMICS Study. PLoS One. 2014 Feb 27;9(2):e89866.Abstract
Background: FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence. Objectives: We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients. Design and Methods: We conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival. Results: A total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.469.7, and predicted FEV1 of 53.8% (+/- 19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild >= 70%, moderate 56-69%, severe 36-55%, and very severe <= 35%. Survival at 5 years was 0.89 for patients with FEV1 >= 70 vs. 0.46 in patients with FEV1 <= 35% (H. R: 6; 95% C. I.: 4.69-7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear. Conclusions: The best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by >= 70%, 56-69%, 36-55%, and <= 35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs.
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https://dx.doi.org/10.1371/journal.pone.0089866MeSH
Area Under CurveAged
Spain
Dyspnea
Pulmonary Disease, Chronic Obstructive
Humans
Forced Expiratory Volume
Middle Aged
Prognosis
Male
Severity of Illness Index
Female
Risk Factors
Cohort Studies
Survival Analysis
Spirometry
DeCS
Estudios de CohortesEspirometría
Análisis de Supervivencia
Femenino
Masculino
Volumen Espiratorio Forzado
Enfermedad Pulmonar Obstructiva Crónica
Factores de Riesgo
Humanos
Persona de Mediana Edad
Pronóstico
Anciano
Índice de Severidad de la Enfermedad
Disnea
España
Área Bajo la Curva