Risk factors for the development of adverse outcomes in patients with chronic obstructive pulmonary disease


DOI: https://dx.doi.org/10.18565/therapy.2022.5.18-25

Karoli N.A., Borodkin A.V., Rebrov A.P.

V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia
Abstract. COPD is one of the leading causes of morbidity and mortality in the world today.
The aim of this study was to identify factors of adverse outcomes in patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD).
Material and methods. In the study was included 103 patients with COPD who were hospitalized in the Department of pulmonology of Saratov regional clinical hospital. All patients was determined the level N-terminal fragment pro-B-type natriuretic peptide (NT pro-BNP), galectin-3, the highly sensitive C-reactive protein, the proteins that bind fatty acids. The study of stiffness of the vascular wall, echocardiography was performed, Charlson index were calculated. A twelve months after study, patients or their relatives were interviewed for revealing adverse outcomes.
Results. After one year, 28 (27,2%) patients with COPD developed chronical heart failure (CHF), 13 (12,6%) had cardiovascular complications and 8 (7,8%) patients died. The risk group the development of acute decompensation of heart failure is composed of patients with chronic bronchitis phenotype in COPD, with increased body weight, with arterial hypertension of more than 10 years, past myocardial infarction, with CHF 3–4 functional classes, having signs of decompensation in the small circulation, angina pectoris, value the Charlson comorbidity index more 4 points, the BODE index more 7 points, elevated levels of red blood cells, hemoglobin, urea, NT-proBNP (more 350 pg/ml). The most significant echocardiographic parameters are the left ventricular dilatation, right and left atrium, a decrease in the left ventricular ejection fraction of less than 45% and elevated systolic pulmonary artery pressure (above 50 mmHg). The increase levels of NT-proBNP and pulse wave velocity is associated with cardiovascular outcome in patients with COPD. The increased of mortality is associated with the severity of heart failure, limited physical activity, the severity of COPD, comorbid pathology and increased arterial stiffness. Predictors of mortality in patients with COPD on one year study was the severity of heart failure (points of SHOC), the severity of COPD (index BODE) and increased arterial stiffness (PWV of day, augmentation index of night).
Conclusion. The results of this study help defined the group of high risk and could improve diagnosis and treatment of COPD.
Keywords: chronical heart failure, chronic obstructive pulmonary disease, arterial stiffness, chronic heart failure, prognosis, mortality
Read entire article

Literature

1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). The updated 2017 report is available at: www.goldcopd.com (date of access – 04.05.2022).


2. Nishimura K., Izumi T., Tsukino M. et al. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest. 2002; 121(5): 1434–40. https://dx.doi.org/10.1378/chest.121.5.1434.


3. Celli B.R., Cote C.G., Marin J.M. et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004; 350(10): 1005–12. https://dx.doi.org/10.1056/NEJMoa021322.


4. Siafakas N.M., Vermeire P., Pride N.B. et al. Optimal assessment and man-agement of chronic obstructive pulmonary disease (COPD). Eur Respir J. 1995; 8(8): 1398–420. https://dx.doi.org/10.1183/09031936.95.08081398.


5. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease: A clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med. 1980; 93(3): 391–98. https://dx.doi.org/10.7326/0003-4819-93-3-391.


6. Gerardi D.A., Lovett L., Benoit-Connors M.L. et al. Variables related to increased mortality following outpatient pulmonary rehabilitation. Eur Respir J. 1996; 9(3): 431–35. https://dx.doi.org/10.1183/09031936.96.09030431.


7. Schols A.M., Slangen J., Volovics L., Wouters E.F. Weight loss is a reversible factor in die prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998; 157(6 Pt 1): 1791–97. https://dx.doi.org/10.1164/ajrccm.157.6.9705017.


8. Landbo C., Prescott E., Lange P. et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999; 160(6): 1856–61. https://dx.doi.org/10.1164/ajrccm.160.6.9902115.


9. Hasegawa W., Yamauchi Y., Yasunaga H., Sunohara M. Factors affecting mortality following emergency admission for chronic obstructive pulmonary disease. BMC Pulm Med. 2014; 14: 151. https://dx.doi.org/10.1186/1471-2466-14-151.


10. Campo G., Pavasini R., Malagu M. et al. Relationship between troponin elevation, cardiovascular history and adverse events in patients with acute exacerbation of COPD. 2015; 12(5): 560–67. https://dx.doi.org/10.3109/15412555.2014.995293.


11. Prudente R., Franco E.A.T., Mesquita C.B. et al. Predictors of mortality in patients with COPD after 9 years. Int J Chron Obstruct Pulmon Dis. 2018; 13: 3389–98. https://dx.doi.org/10.2147/COPD.S174665.


12. Almagro P., Soriano .J.B., Cabrera F.J. et al. Short- and medium-term prognosis in patients hospitalized for COPD exacerbation: the CODEX index. Chest. 2014; 145(5): 972–80. https://dx.doi.org/10.1378/chest.13-1328.


13. Golpe R., Suarez-Valor M., Martín-Robles I. et al. Mortality in COPD patients according to clinical phenotypes. Int J Chron Obstruct Pulmon Dis. 2018; 13: 1433–39. https://dx.doi.org/10.2147/COPD.S159834.


14. Кароли Н.А., Ребров А.П. Факторы риска смерти пациентов с хронической обструктивной болезнью легких. Клиническая медицина. 2006; 9: 24–27. [Karoli N.A., Rebrov A.P. Mortality risk factors in patients with chronic obstructive pulmonary disease. Klinicheskaya meditsina = Clinical Medicine. 2006; 9: 24–27 (In Russ.)]. EDN: HVSSTB.


15. Кароли Н.А., Ребров А.П. Индекс BODE как предиктор неблагоприятного прогноза при хронической обструктивной болезни легких (по результатам проспективного динамического наблюдения). Терапевтический архив. 2007; 3: 11–14. [Karoli N.A., Rebrov A.P. Index BODE – predictors of outcome in patients with chronic obstructive pulmonary disease (according to the data of prospective dynamic observation). Terapevticheskiy arkhiv = Therapeutic Archive. 2007; 3: 11–14 (In Russ.)]. EDN: HZWGFJ.


16. Ahn Y.H., Lee K.S., Park J.H. et al. Independent risk factors for mortality in patients with chronic obstructive pulmonary disease who undergo comprehensive cardiac evaluations. Respiration. 2015; 90(3): 199–205. https://dx.doi.org/10.1159/000437097.


17. Lynn J., Ely E.W., Zhong Z. et al. Living and dying with chronic obstructive pulmonary disease. J Am Geriatr Soc. 2000; 48(S1): S91–100. https://dx.doi.org/10.1111/j.1532-5415.2000.tb03147.x.


18. Perera P.N., Armstrong E.P., Sherrill D.L., Skrepnek G.H. Acute exacerbations of COPD in the United States: Inpatient burden and predictors of costs and mortality. COPD. 2012; 9(2): 131–41. https://dx.doi.org/10.3109/15412555.2011.650239.


19. Арутюнов А.Г., Драгунов Д.О., Арутюнов Г.П. с соавт. Первое открытое исследование синдрома острой декомпенсации сердечной недостаточности и сопутствующих заболеваний в Российской Федерации. Независимый регистр ОРАКУЛ-РФ. Кардиология. 2015; 5: 12–21. [Arutyunov A.G., Dragunov D.O., Arutjunov G.P. et al. First open study of syndrome of acute decompensation of heart failure and concomitant diseases in Russian Federation: Independent Registry ОRAKUL. Kardiologiya = Cardiology. 2015; 5: 12–21 (In Russ.)]. https://dx.doi.org/10.18565/cardio.2015.5.12-21. EDN: TZWNFP.


20. Ruiz-Laiglesia F.J., Sanchez-Marteles M., Perez-Calvo J.I. et al. Comorbidity in heart failure. Results of the Spanish RICA Registry. QJM. 2014; 107(12): 989–94. https://dx.doi.org/10.1093/qjmed/hcu127.


21. Pavasini R., Tavazzi G., Biscaglia S. et al. Amino terminal pro brain natriuretic peptide predicts all-cause mortality in patients with chronic obstructive pulmonary disease: Systematic review and meta-analysis. Chron Respir Dis. 2017; 14(2): 117–26.https://dx.doi.org/10.1177/1479972316674393.


22. Sato M., Inoue S., Igarashi A. et al. Heart-type fatty acid binding protein as a prognostic factor in patients with exacerbated chronic obstructive pulmonary disease. Respir Investig. 2018; 56(2): 128–35. https://dx.doi.org/10.1016/j.resinv.2017.11.010.


23. Кошелева Н.А., Ребров А.П. Факторы риска развития сердечно-сосудистых осложнений у больных хронической сердечной недостаточностью: фокус на артериальную жесткость. Журнал сердечная недостаточность. 2011; 3: 136–141. [Kosheleva N.A., Rebrov A.P. Risk factors of cardiovascular complications in patients with chronic heart failure: focus on arterial stiff-ness. Zhurnal serdechnaya nedostatochnost’ = Journal of Heart Failure. 2011; 3: 136–141 (In Russ.)]. EDN: OZDQYR.


24. Орлова Я.А., Агеев Ф.Т. Жесткость артерий как интегральный показатель сердечно-сосудистого риска: физиология, методы оценки и медикаментозной коррекции. Сердце: журнал для практикующих врачей. 2006; 2: 65–69. [Orlova Ya.A., Ageev F.T. Arteries rigidity – integral index of cardiovascular risk: physiology, methods of assessment and therapy. Serdtse: zhurnal dlya praktikuyushchikh vrachey = Heart: Journal for Practitioners. 2006; 2: 65–69 (In Russ.)]. EDN: PXJSXL.


25. Васюк Ю.А., Иванова С.В., Школьник Е.Л. с соавт. Согласованное мнение российских экспертов по оценке артериальной жесткости в клинической практике. Кардиоваскулярная терапия и профилактика. 2016; 2: 4–19. [Vasjuk Yu.A., Ivanova S.V., Shkolnik E.L. et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2016; 2: 4–19 (In Russ.)].https://dx.doi.org/10.15829/1728-8800-2016-2-4-19. EDN: VUWMTP.


About the Autors

Nina A. Karoli, Dr. med. habil., professor of the Department of hospital therapy of the Faculty of general medicine, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. E-mail: nina.karoli.73@gmail.com. ORCID: https://orcid.org/0000-0002-7464-826X
Andrey V. Borodkin, postgraduate student of the Department of hospital therapy of the Faculty of general medicine, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. E-mail: kapricorn@yandex.ru
Andrey P. Rebrov, Dr. med. habil., professor, head of the Department of hospital therapy of the Faculty of general medicine, V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. E-mail: andreyrebrov@yandex.ru. ORCID: https://orcid.org/0000-0002-3463-7734


Similar Articles

Back to Content

Бионика Медиа