Abstract
BackgroundThe association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD) is well established, but it is unknown whether disease-specific health status measures and multidimensional assessment (MDA) have comparable prognostic value.MethodsWe analyzed data coming from the Salute Respiratoria nell'Anziano (Respiratory Health in the Elderly – SaRA) study, enrolling elderly people attending outpatient clinics for respiratory and non-respiratory problems. From this population we selected 449 patients with bronchial obstruction (77.3% men, mean age 73.1). We classified patients' health status using tertiles of the Saint George Respiratory Questionnaire (SGRQ) and a MDA including functional (the 6' walking test, WT), cognitive (Mini-Mental State Examination, MMSE) and affective status (Geriatric Depression Scale, GDS). The agreement of the classification methods was calculated using the kappa statistic, and survival associated with group membership was evaluated using survival analysis.ResultsPulmonary function, expressed by the FEV1, worsened with increasing SGRQ or MDA scores. Cognitive function was not associated with the SGRQ, while physical performance and mood status were impaired only in the highest tertile of SGRQ. A poor agreement was found between the two classification systems tested (k = 0.194). Compared to people in the first tertile of SGRQ score, those in the second tertile had a sex-adjusted HR of 1.22 (0.75 – 1.98) and those in the third tertile of 2.90 (1.92 – 4.40). The corresponding figures of the MDA were 1.49 (95% CI 1.02 – 2.18) and 2.01 (95% CI: 1.31 – 3.08). After adjustment for severity of obstruction, only a SGRQ in the upper tertile was associated with mortality (HR: 1.86; 95% CI: 1.14 – 3.02).ConclusionIn elderly outpatients with mild-moderate COPD, a disease-specific health status index seems to be a better predictor of death compared to a MDA.
Highlights
The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD) is well established, but it is unknown whether diseasespecific health status measures and multidimensional assessment (MDA) have comparable prognostic value
All the patients underwent health status assessment by the disease-specific Saint George Respiratory Questionnaire (SGRQ) [17] and a geriatric MDA covering several areas: social and environmental status, personal history of smoking habit, physical functioning as expressed by the distance walked in 6-minute (WD) [18], cognitive function rated by the Mini Mental Status Examination (MMSE) [19], and mood status assessed by the 15-item Geriatric Depression Scale (GDS) [20]
The proportion of men was constant across SGRQ classes, while it linearly decreased as impairment in the MDA increased
Summary
The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD) is well established, but it is unknown whether diseasespecific health status measures and multidimensional assessment (MDA) have comparable prognostic value. Instruments rating disease-specific health status might lose part of their prognostic value because they have been developed in adult COPD populations free from or with minor comorbidity [3,7]. Simple indicators of performance in physical and cognitive domains may predict survival of COPD patients because they are effective in broad elderly populations with multiple chronic diseases [8,9]. Both cognitive impairment and poor physical performance have been associated with worse survival in patients with chronic heart failure [10,11]. Being applicable in different populations, performance indexes can provide information on prognosis independently of the main diagnosis, allowing to compare prognosis of patients with different underlying disease
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