Investigation Of Comorbidities In Patients With Stable COPD And Analysis Of Risk Factors And Predictive Value Affecting AECOPD In Shanghai Area

Background and Objective:COPD is a common chronic airway disease characterized by persistent airflow limitation.It is common in the middle-aged and elderly.Its morbidity and mortality are increasing year by year,and the treatment methods are limited.It not only seriously threatens the life and health of patients,but also brings heavy financial burden to individuals,families and society.In recent years,with the in-depth understanding of the COPD,researchers found that COPD patients with high incidence of comorbidities,which are large individual differences and regional differences,which can affect the prognosis of patients to different degrees and bring difficulties to management.At present,it’s still lacking sduty about the distribution characteristics of comorbidities and its predictive value for AECOPD in Shanghai area.The main purpose of this study was to investigate the distribution characteristics of comorbidities in stable COPD patients in Shanghai,analyzed the related risk factors which affecting AECOPD and explored the predictive value of comorbidities for AECOPD.Methods:The first part A multi-center,cross-sectional survey was conducted to collect the clinical datum of 532 stable COPD patients in the respiratory department of 14 Tier2 and Tier3 hospitals in Shanghai area and the 33 kinds of comorbidities in 8 systemsin of them from October 2018 to August 2019.Comorbidities were given score with Charlson comorbidity index（CCI）.According to the COPD Assessment Test（CAT）or the modified British Medical Research Council（m MRC）and the times of frequent exacerbations of COPD in the past 12 months,the patients were divided into multi-symptom group（CAT≥10 scores or m MRC≥2 scores）and few-symptom group（CAT<10 scores or m MRC0-1scores）,frequent exacerbations（FE）group and non-frequent exacerbations（NFE）group,to compare and analyze the distribution characteristics and clinical significance of comorbidities between different groups,and also compare them with high-CCI group（≥4score）and low-CCI group（<4 score）.The correlation between major comorbidity and COPD severity was analyzed by logistic analysis.The second part Detailed clinical datum and comorbidities of 113 stable COPD patients in the respiratory department of 3hospitals of that were collected by multi-center cross-sectional investigation.Compared and analyzed the clinical characteristics in FE and NFE groups for the influence of AECOPD.The third part A single-center and prospective cohort study the clinical datas of the 57 patients with stable COPD who were followed up for 12 months in our hospital.They were divided into FE group and NFE group to analyze the predictive value of COPD comorbidities for AECOPD and the related risk factor of that.The results were analyzed by SPSS21.0 software.Normally distributed measurement data were expressed as mean±standard deviation（SD）（x±s）,and comparisons were made between groups by t test.Unnormal distribution measurement data were expressed as medians（quartile）[M（QR）],and comparisons were made between groups by the Wilcoxon rank-sum tests.Counting data were expressed as percentages（%）,and comparisons were made between groups using Chi-squared tests（x²）.Logistic regression was used to analyze the correlation between COPD severity and complications.A value of P<0.05 was considered significant for all analyses.Results:In the first part of study,a total of 28 kinds of comorbidities were collected in the 532patients.The prevalence rate of the comorbidities was 73.9%（n=393）.The per capita number of comorbidities was（1.9±1.7）（0-12）kinds.The mean CCI was（3.6±1.6）（0～13）.According to the classification of diseases,the top 8 diseases were pulmonary hypertension（34.2%）,hypertension（27.1%）,asthma（25.4%）,metabolic syndrome（22.9%）,allergic rhinitis（10.9%）,bronchiectasis（8.8%）,allergic dermatitis（8.1%）and stroke（6.6%）.According to the systematic classification,the top 4 diseases were chronic lung disease（41.5%）,allergic disease（34.4%）,cardiovascular disease（32.3%）and metabolic diseases（26.5%）.The incidence of bronchiectasis in the FE group was significantly higher than that in the NFE group（11.6%vs.6.0%,P=0.024）,and the significant positive correlation was showed（OR=2.127,95%CI:1.114-4.060,P=0.022）.Compared with the low-CCI group,hypertension and metabolic syndrome in high-CCI group were significantly higher than those in low-CCI group,and logistic regression analysis showed statisticaldifference（OR=1.982,95%CI:1.328-2.956,P=0.001;OR=3.308,95%CI:2.140-5.114,P<0.001）.In the second part of study,the BMI,HGB,FEV₁/FVC%,FEV1%pred of patients in the FE group were significantly lower than that in the NFE group（P<0.05）,but the SGRQ scores and serum total Ig E were significantly higher than that in the NFE group（P<0.05）.The incidence of comorbidities was 87.6%in 113 patients.The incidence of malignant tumor in the FE group was significantly lower than that in the NFE group according to the systematic classification（11.7%vs.30.2%,P=0.015）.In the third part of study,a total of 22 comorbidities were collected from 57 patients with COPD.The 57 patients were followed up one year.The incidence of comorbidities was 91.2%in 57 patients.The mean CCI score was 3.8±1.5 points（1-10 points）.There were no statistical difference in the CCI score and the distribution of comorbidities in the FE group and the NFE group.General clinical features by the univariate logistic regression analysis revealed that the SGRQ scores was significantly positive correlated with FE（OR=1.059,95%CI:1.001-1.120,P=0.046）.The specificity of SGRQ scores for FE was84.2%,the sensitivity of that was 60.5%,and the area under the ROC curve was 0.724,P=0.006.Conclusion:1.There was a high incidence of comorbidities in patients with stable COPD in Shanghai.The main comorbidities were cardiovascular diseas,allergic disease and metabolic diseas;The incidence of patients with hypertension and metabolic syndrome in high-CCI group were higher than that of in low-CCI group;In the FE group,bronchiectasis maybe a risk factor for acute exacerbation of COPD;Malignant tumor diseases were mainly distributed in the NFE group.2.Patients in FE group had a poor nutritional status,poor lung functions and high serum total Ig E.Improving nutritional status,lung functions and suppressing inflammation would help us to better control acute exacerbation of COPD.3.Prospective cohort studies indicated that comorbidities and CCI index had no significant predictive value for AECOPD.The SGRQ scores maybe the predictors of future acute exacerbations of COPD.