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COPD Mortality: A Competing Risk Analysis
Obstructive Lung Diseases SESSION TITLE: Airways 4 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
COPD Mortality: A Competing Risk Analysis Jawad Abukhalaf MD Ross Davidson MD; and Rodrigo Vazquez-Guillamet MD* University of New Mexico, Albuquerque, NM PURPOSE: Traditionally, most studies investigating COPD mortality used all cause mortality as an outcome. We aimed to investigate risk factors for the three most common causes of mortality in COPD: malignancy, cardiovascular disease and respiratory failure
RESULTS: In this preliminary analysis we had a total of 247 patients with COPD. Median age was 65.7 (SD +/- 9.9). 48.9% were males. Mean FEV1 was 53.3% (+/- 17) predicted. Most patients were GOLD stage 2(52.6%) and 3(32.4%). There were 37(15%) total deaths. 16(6.5%) patients died of respiratory complications. 9(3.6%) patients died of malignancy. 6(2.4%) patients died of cardiovascular disease and the rest died at home of unclear etiologies. CCI (HR 1.25, 95% CI: 1.07-1.45) and GOLD spirometric class (HR 1.66, 95% CI: 1.02- 2.7) were associated with increased all-cause mortality. Compared with those who died of respiratory complications, those who died of malignancy were slightly younger (63.7 yrs vs 65.8 yrs, P ¼ o.o46). Otherwise, there were no significant differences between the two populations in terms of gender, mean FEV1 value or GOLD stage. Risk factors for respiratory death included all variables linked with worsening respiratory function, presence of emphysema on CT chest (sHR 3.47, 95% CI 1.12-10.75), worsening GOLD spirometric stage; GOLD 4 (sHR 8.50, 95% CI 3.02-23.95). Weight was protective(sHR 0.96, 95% CI 0.93-0.99), as were increasing FEV1(sHR 0.94, 95% CI 0.89-0.99), and increasing DLCO(sHR 0.96, 95% CI 0.94-0.99) , the Charlson Comorbidity Index showed no association with respiratory mortality(sHR 0.99, 95% CI 0.821.19). Patients with simultaneous ILD and COPD were significantly more likely to die from malignancy(sHR 13.46, 95% CI 3.4652.28). CONCLUSIONS: Cause-specific mortality risk factors are different for respiratory deaths and deaths related to malignancy in this population of COPD patients, they are also different from risk factors for all-cause mortality CLINICAL IMPLICATIONS: Our results have implications for the assessment of mortality risk from specific causes and can be the stepping stone for the assessment of preventative strategies for each of them DISCLOSURE: The following authors have nothing to disclose: Jawad Abukhalaf, Ross Davidson, Rodrigo Vazquez-Guillamet No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.961
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
861A
OBSTRUCTIVE LUNG DISEASES
METHODS: The study is conducted at the University of New Mexico Hospital in Albuquerque (USA), a safety net 450 bed University Hospital. Subjects were included in the study based on the presence of an obstructive spirometry (FEV1/FVC<70) and history of smoking. Data was collected retrospectively using the hospital medical records system from 2000 to 2015, icluding demographics, comorbidities as described in the COTE and Charlson index (CCI), COPD specific therapies, spirometry results and mortality. Survival was calculated from study until death, patients who did not die were right censored on 12/31/2015. Continous variables were compared using t-test or rank sum test as approtpriate. Categorical variables were compared using chisqaured test . We first explored risk factors for all-cause mortality using Cox proportional hazards model then using competing risk analysis. Using malignancy, cardiovascular and respiratory death as competing risks for each other we calculated cause specific mortality for COPD and malignancy
COPD Mortality: A Competing Risk Analysis Jawad Abukhalaf MD Ross Davidson MD; and Rodrigo Vazquez-Guillamet MD* University of New Mexico, Albuquerque, NM PURPOSE: Traditionally, most studies investigating COPD mortality used all cause mortality as an outcome. We aimed to investigate risk factors for the three most common causes of mortality in COPD: malignancy, cardiovascular disease and respiratory failure
RESULTS: In this preliminary analysis we had a total of 247 patients with COPD. Median age was 65.7 (SD +/- 9.9). 48.9% were males. Mean FEV1 was 53.3% (+/- 17) predicted. Most patients were GOLD stage 2(52.6%) and 3(32.4%). There were 37(15%) total deaths. 16(6.5%) patients died of respiratory complications. 9(3.6%) patients died of malignancy. 6(2.4%) patients died of cardiovascular disease and the rest died at home of unclear etiologies. CCI (HR 1.25, 95% CI: 1.07-1.45) and GOLD spirometric class (HR 1.66, 95% CI: 1.02- 2.7) were associated with increased all-cause mortality. Compared with those who died of respiratory complications, those who died of malignancy were slightly younger (63.7 yrs vs 65.8 yrs, P ¼ o.o46). Otherwise, there were no significant differences between the two populations in terms of gender, mean FEV1 value or GOLD stage. Risk factors for respiratory death included all variables linked with worsening respiratory function, presence of emphysema on CT chest (sHR 3.47, 95% CI 1.12-10.75), worsening GOLD spirometric stage; GOLD 4 (sHR 8.50, 95% CI 3.02-23.95). Weight was protective(sHR 0.96, 95% CI 0.93-0.99), as were increasing FEV1(sHR 0.94, 95% CI 0.89-0.99), and increasing DLCO(sHR 0.96, 95% CI 0.94-0.99) , the Charlson Comorbidity Index showed no association with respiratory mortality(sHR 0.99, 95% CI 0.821.19). Patients with simultaneous ILD and COPD were significantly more likely to die from malignancy(sHR 13.46, 95% CI 3.4652.28). CONCLUSIONS: Cause-specific mortality risk factors are different for respiratory deaths and deaths related to malignancy in this population of COPD patients, they are also different from risk factors for all-cause mortality CLINICAL IMPLICATIONS: Our results have implications for the assessment of mortality risk from specific causes and can be the stepping stone for the assessment of preventative strategies for each of them DISCLOSURE: The following authors have nothing to disclose: Jawad Abukhalaf, Ross Davidson, Rodrigo Vazquez-Guillamet No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.961
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
861A
OBSTRUCTIVE LUNG DISEASES
METHODS: The study is conducted at the University of New Mexico Hospital in Albuquerque (USA), a safety net 450 bed University Hospital. Subjects were included in the study based on the presence of an obstructive spirometry (FEV1/FVC<70) and history of smoking. Data was collected retrospectively using the hospital medical records system from 2000 to 2015, icluding demographics, comorbidities as described in the COTE and Charlson index (CCI), COPD specific therapies, spirometry results and mortality. Survival was calculated from study until death, patients who did not die were right censored on 12/31/2015. Continous variables were compared using t-test or rank sum test as approtpriate. Categorical variables were compared using chisqaured test . We first explored risk factors for all-cause mortality using Cox proportional hazards model then using competing risk analysis. Using malignancy, cardiovascular and respiratory death as competing risks for each other we calculated cause specific mortality for COPD and malignancy