Preserved Ratio Impaired Spirometry (PRISm) and mortality: the Rotterdam Study

Abstract

Introduction: Longitudinal studies on PRISm are scarce but studies in smoking populations have suggested worse outcomes. Objective: To compare mortality in PRISm subjects with COPD and normal spirometry in the general population. Methods: In a population-based study enrolling subjects aged ≥45 (asthma excluded), we examined all-cause and cardiovascular (CV) mortality in subjects with PRISm (FEV1/FVC≥0.7 and FEV1 Results: Of 4824 participants (69.1±8.9 years, 45.4% males), 3703 (76.8%) had normal spirometry, 324 (6.7%) had PRISm and 797 (16.5%) had COPD. During 4.2 years of follow-up, 619 (12.8%) participants died; 379 (10.2%) controls, 62 (19.1%) PRISm subjects and 178 (22.3%) COPD subjects. Relative to controls, PRISm and COPD GOLD2-3 had increased risks of all-cause and CV mortality (PRISm: HR 1.7 [1.3 -2.2] and 2.3 [1.2-4.5]; COPD: HR 1.8 [1.4-2.2] and 1.9 [1.1-3.5]). Risks of all-cause and CV mortality were increased in PRISm relative to COPD GOLD1 (HR 1.8 [1.2-2.5] and HR 4.6 [1.3-16.6]), but were not different in PRISm relative to COPD GOLD2-3 (HR 0.9 [0.7-1.3] and HR 1.2 [0.6-2.5]). Conclusion: In the general population, PRISm is associated with increased all-cause and CV mortality compared to subjects with normal spirometry and COPD GOLD1.