Lity rates were very high with 20/97 (20.6 ) deaths. Phenotype 3 (n = 209 subjects) mostly corresponded to male subjects with a median [IQR] age of 72 [65?7] yrs., and moderate to severe airflow limitation. These subjects had less severe emphysema than subjects in Phenotype 2, but higher prevalence of bronchial thickening. They were often obese and had high rates of diabetes and cardiovascular comorbidities. Six subjects were lost to follow-up and mortality rates were also high with 29/203 (14.3 ) deaths.was observed between Phenotype 2 and 3. Because age at inclusion was markedly different between these latter phenotypes (median age, 61 yrs. vs. 72 yrs.), we hypothesized that subjects in Phenotype 2 had died earlier in life than subjects in Phenotype 3. Median [IQR] age of death was 64.5 [60.4?8.9] yrs. in Phenotype 2 (n = 16) and was 75.9 [70.8?7.8] yrs. in Phenotype 3 (n = 25). To take this difference into account, we performed Cox model analyses of mortality using phenotypes and age as covariates (Table 3). After adjustment for age, subjects in Phenotype 2 had a 3-fold increase in mortality compared with subjects in Phenotype 3.DiscussionIn this large population of COPD subjects with a wide range of airflow limitation, we Title Loaded From File identified three COPD phenotypes, including one phenotype at low risk of mortality and two distinct phenotypes (Phenotype 2 and 3) at high risk of mortality. Phenotype 2 included younger patients with severe respiratory disease, low BMI and low rates of cardiovascular comorbidities. Phenotype 3 included older patients with less severe airflow limitation, but who were often obese and had higher rates of cardiovascular comorbidities and diabetes. These findings suggest that different strategies for improving outcome should be proposed to these two groups of COPD patients. We have identified clusters of COPD subjects, which were associated with different mortality rates and patterns, qualifying as phenotypes [6]. In a French cohort of COPD subjects, investigators identified four clusters of subjects, including two clusters of subjects at high risk of predicted mortality [11]. In the present study, the two phenotypes that were at high risk of actual mortalitySurvival Pattern According to PhenotypesMedian [IQR] follow-up times were 2.4 [1.8; 2.9] yrs. 1317923 for Phenotype 1, 2.3 [1.8; 2.8] yrs. for Phenotype 2, and 2.5 [2.1; 2.9] yrs. for Phenotype 3 and were not significantly different (P = 0.13; Kruskal-Wallis test). When Title Loaded From File comparing Phenotypes 2 and 3, in which subjects were at high risk of mortality, the pattern of mortality was different. In Phenotype 2, 75 of subjects who died were in GOLD stage IV and 25 were in GOLD stage III, indicating that the mortality pattern followed the severity of airflow obstruction. By contrast, in Phenotype 3, mortality distributed among all GOLD stages (Figure 3). Kaplan-Meier analysis of mortality between the 3 phenotypes is presented in Figure 4. Subjects in Phenotype 2 and 3 were at higher risk of mortality than subjects in Phenotype 1 (each comparison, P,0.0001; log-rank test), but no significant differenceCOPD Phenotypes at High Risk of MortalityTable 2. Description of the 527 COPD patients based on phenotypes identified by cluster analysis.Phenotype 1 n = 219 DATA USED IN THE CLUSTER ANALYSIS Quantitative data Age, yrs. BMI, kg/m2 FEV1, predicted Dyspnoea, mMRC scale Clinical COPD Questionnaire, Total TGV, predicted DLCO, predicted Categorical data CT scan* Emphysema present,.Lity rates were very high with 20/97 (20.6 ) deaths. Phenotype 3 (n = 209 subjects) mostly corresponded to male subjects with a median [IQR] age of 72 [65?7] yrs., and moderate to severe airflow limitation. These subjects had less severe emphysema than subjects in Phenotype 2, but higher prevalence of bronchial thickening. They were often obese and had high rates of diabetes and cardiovascular comorbidities. Six subjects were lost to follow-up and mortality rates were also high with 29/203 (14.3 ) deaths.was observed between Phenotype 2 and 3. Because age at inclusion was markedly different between these latter phenotypes (median age, 61 yrs. vs. 72 yrs.), we hypothesized that subjects in Phenotype 2 had died earlier in life than subjects in Phenotype 3. Median [IQR] age of death was 64.5 [60.4?8.9] yrs. in Phenotype 2 (n = 16) and was 75.9 [70.8?7.8] yrs. in Phenotype 3 (n = 25). To take this difference into account, we performed Cox model analyses of mortality using phenotypes and age as covariates (Table 3). After adjustment for age, subjects in Phenotype 2 had a 3-fold increase in mortality compared with subjects in Phenotype 3.DiscussionIn this large population of COPD subjects with a wide range of airflow limitation, we identified three COPD phenotypes, including one phenotype at low risk of mortality and two distinct phenotypes (Phenotype 2 and 3) at high risk of mortality. Phenotype 2 included younger patients with severe respiratory disease, low BMI and low rates of cardiovascular comorbidities. Phenotype 3 included older patients with less severe airflow limitation, but who were often obese and had higher rates of cardiovascular comorbidities and diabetes. These findings suggest that different strategies for improving outcome should be proposed to these two groups of COPD patients. We have identified clusters of COPD subjects, which were associated with different mortality rates and patterns, qualifying as phenotypes [6]. In a French cohort of COPD subjects, investigators identified four clusters of subjects, including two clusters of subjects at high risk of predicted mortality [11]. In the present study, the two phenotypes that were at high risk of actual mortalitySurvival Pattern According to PhenotypesMedian [IQR] follow-up times were 2.4 [1.8; 2.9] yrs. 1317923 for Phenotype 1, 2.3 [1.8; 2.8] yrs. for Phenotype 2, and 2.5 [2.1; 2.9] yrs. for Phenotype 3 and were not significantly different (P = 0.13; Kruskal-Wallis test). When comparing Phenotypes 2 and 3, in which subjects were at high risk of mortality, the pattern of mortality was different. In Phenotype 2, 75 of subjects who died were in GOLD stage IV and 25 were in GOLD stage III, indicating that the mortality pattern followed the severity of airflow obstruction. By contrast, in Phenotype 3, mortality distributed among all GOLD stages (Figure 3). Kaplan-Meier analysis of mortality between the 3 phenotypes is presented in Figure 4. Subjects in Phenotype 2 and 3 were at higher risk of mortality than subjects in Phenotype 1 (each comparison, P,0.0001; log-rank test), but no significant differenceCOPD Phenotypes at High Risk of MortalityTable 2. Description of the 527 COPD patients based on phenotypes identified by cluster analysis.Phenotype 1 n = 219 DATA USED IN THE CLUSTER ANALYSIS Quantitative data Age, yrs. BMI, kg/m2 FEV1, predicted Dyspnoea, mMRC scale Clinical COPD Questionnaire, Total TGV, predicted DLCO, predicted Categorical data CT scan* Emphysema present,.
