Supervivencia en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica acorde a la clasificación GOLD 2017 / Survival in a cohort of patients with chronic obstructive pulmonary disease according to GOLD 2017 classification

Hasta el momento, no existe información sobre la evolución de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) de acuerdo con la nueva clasificación GOLD 2017. El objetivo de este estudio fue determinar, en una cohorte de pacientes con EPOC seguidos por veinte años, la influencia del cambio a la nueva clasificación en resultados de supervivencia por grupos y su asociación con otras variables como comorbilidades. Se evaluaron enfermos con EPOC (definición GOLD 2017) con seguimiento desde enero de 1996 a diciembre de 2016. Se usaron estadísticas convencionales y análisis de supervivencia de Log- Rank (Mantel-Cox). Se analizaron 354 pacientes: edad 66.5 ± 8.4, 66.7% hombres; ex-tabaquistas: 74.2% (56 paquetes-año); índice de Charlson 4.1 ± 1.7. A los 20 años, estaban vivos 219 (62%) y fallecidos 135 (38%), con un seguimiento de 28 meses (12-54.7). En el análisis uni y multivariado, el sexo masculino y la edad se asociaron a mayor mortalidad. Teniendo en cuenta solo la espirometría, a peor grado de obstrucción al flujo aéreo, la supervivencia es menor. Con la clasificación ABCD 2017, la peor supervivencia se encuentra en el grupo D y solo en este grupo es independiente del nivel de deterioro del VEF1 (p = 0.005). La nueva clasificación ABCD es predictora de mortalidad solo si está asociada a la función pulmonar.

Until now, there is no information on the evolution of patients with chronic obstructive pulmonary disease (COPD) according to the new GOLD classification. The objective of this study was to determine, in a cohort of patients with COPD followed by twenty years, the impact of the change to the new classification: survival by groups and their association with other variables such as comorbidities. COPD patients (GOLD 2017 definition) were evaluated with follow-up since January 1996 to December 2016. Conventional statistics and Log-Rank survival analysis (Mantel-Cox) were used. We analyzed 354 patients: age 66.5 ± 8.4, 66.7% men. Former smokers 74.2% (56 pack-year). Charlson index 4.1 ± 1.7. At the end of study 219 (62%) were alive and 135 (38%) died. The follow-up was 28 months (12-54.7). In the univariate and multivariate analysis, male sex and age were associated with higher mortality. Considering only the spirometry, to a worse degree of airflow obstruction, corresponded a lower survival. With the ABCD 2017 classification, the worst survival was observed in group D. Only in this group, survival is independent of the level of deterioration of FEV1 (p = 0.005). The new ABCD classification is a mortality predictor, only if it is associated to pulmonary function.

Study on the Nutrition Status in Patients with COPD / 医学研究杂志

Objective To investigate the parameters of nutrition status in the patients with COPD and study the difference nutrition status among COPD GOLD classification including A, B,C and D.Methods According to the global initiative for chronic obstructive lung disease ( GOLD) criteria, we classified the COPD outpatients into A, B, C, D group, with 10 cases in each group, 20 cases healthy people as control group as well as 20 patients with chronic bronchitis.Body mass index ( BMI) , triceps skin-fold thickness( TSF) ,ser-um albumin ( ALB ) were measured in each person.Results BMI was significantly lower in COPD group than health control group (21.3 ±4.0kg/m2 vs 24.7 ±3.7kg/m2, P<0.01) ; TSF was significantly reduced in COPD group than the control group (10.3 ± 4.4mm vs 13.0 ±4.4mm, P<0.05);ALB in COPD group was significant decreased than the control group (34.4 ±5.3g/L vs 39.5 ± 6.7g/L, P<0.01).Moreover, there were significantly differences in the nutrition status among COPD groups.BMI in the group of(C+D) was significantly lower compared with the group of (A+B) (19.9 ±4.3kg/m2 vs 22.1 ±3.5kg/m2, P<0.05).TSF was significant-ly decreased in the group of (C+D) than the group of (A+B)(7.7 ±2.4mm vs 12.9 ±4.4mm, P<0.01).Compared with the group of (A+B), ALB was also significantly reduced in the group of (C+D)(32.3 ±4.5g/L vs 36.5 ±5.4g/L, P<0.01).Conclusion The parameters of BMI, TSF, ALB are significantly reduced in the patients with COPD.Severe COPD easily develops malnutrition.Ac-cording to COPD GOLD classification, the nutrition status is worse in the group of ( C+D) than in the group of ( A+B) .It is worthy to pay attention to the nutrition status of COPD patients, and give appreciate therapy for patients with COPD.