Difference in survival between COPD patients with an impaired immune reaction versus an adequate immune reaction to seasonal influenza vaccination: The COMIC study.

AIM: To study the hypothesis that COPD patients who do not achieve seroprotective levels after influenza vaccination, are a less immune-competent group with a higher risk of morbidity and mortality. METHODS: 578 patients included in the COMIC cohort had pre- and post-vaccination stable state blood samples in which influenza-vaccine specific antibodies were measured. Post-vaccination titers of ≥40 were considered protective and indicative of being immuno-competent. Primary outcome was all-cause mortality. Morbidity was defined as time till first severe acute exacerbation in COPD (severe AECOPD) and time till first community acquired pneumonia (CAP). RESULTS: 42% of the patients achieved seroprotective levels to both H1N1 and H3N2 after vaccination. Seroprotective levels to H3N2 were markedly higher (96%) than to H1N1(43%). Having seroprotective levels to both H1N1 and H3N2 was not associated with less morbidity (severe AECOPD HR 0.91 (95% 0.66-1.25; p = 0.564) (CAP HR 1.23 (95% 0.75-2.00; p = 0.412)) or lower mortality (HR 1.10(95% 0.87-1.38; p = 0.433)). CONCLUSION: In a large well-characterized COPD cohort only the minority of patients achieved seroprotective titers to H1N1 and H3N1 after the yearly influenza vaccination. While achieving seroprotection after vaccination can be considered a surrogate marker of being immunocompetent, this was not associated with lower morbidity and mortality. Whether this means that the immune status is not a relevant pheno/endotype in COPD patients for the course of their disease or that seroprotection is not an adequate (surrogate) marker to define the immune status in COPD needs to be further studied.

Comparing the 2007 and 2011 GOLD Classifications as Predictors of all-Cause Mortality and Morbidity in COPD.

To better classify patients with chronic obstructive pulmonary disease (COPD) for prognostic purposes and to tailor treatment, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007 classification was revised in 2011. The primary aim of the current data analyses was to evaluate the accuracy of the GOLD 2007 and 2011 GOLD classifications to predict all-cause mortality and morbidity in a well-described COPD cohort. The prognostic values of both GOLD classifications, expressed as the C-statistic, were assessed in the Cohort of Mortality and Inflammation in COPD (COMIC) study of 795 COPD patients, with a follow-up of 3 years. Outcomes were all-cause mortality and morbidity. Morbidity was defined as time until first COPD-related hospitalisation and time until first community-acquired pneumonia (CAP). The prognostic value of the GOLD 2011 classification was compared between symptom classification based on the modified Medical Research Council (mMRC) score and the Clinical COPD Questionnaire (CCQ) scores with two different thresholds. Although the GOLD 2011 CCQ classification had the highest accuracy to predict mortality and morbidity in our study, the C-statistics differed only numerically. Furthermore, our study showed that the instrument used to determine the level of symptoms in the GOLD 2011 classification has not only important consequences on the mortality prognosis, but also affects the morbidity prognosis in COPD. Therefore, patients' estimated prognosis could alter when different types of tools are used to evaluate the prognosis.