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Using Cluster Analysis to Identify Phenotypes and Validation of Mortality in Men with COPD

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Abstract

Purpose

Cluster analysis has been proposed to examine phenotypic heterogeneity in chronic obstructive pulmonary disease (COPD). The aim of this study was to use cluster analysis to define COPD phenotypes and validate them by assessing their relationship with mortality.

Methods

Male subjects with COPD were recruited to identify and validate COPD phenotypes. Seven variables were assessed for their relevance to COPD, age, FEV1 % predicted, BMI, history of severe exacerbations, mMRC, SpO2, and Charlson index. COPD groups were identified by cluster analysis and validated prospectively against mortality during a 4-year follow-up.

Results

Analysis of 332 COPD subjects identified five clusters from cluster A to cluster E. Assessment of the predictive validity of these clusters of COPD showed that cluster E patients had higher all cause mortality (HR 18.3, p < 0.0001), and respiratory cause mortality (HR 21.5, p < 0.0001) than those in the other four groups. Cluster E patients also had higher all cause mortality (HR 14.3, p = 0.0002) and respiratory cause mortality (HR 10.1, p = 0.0013) than patients in cluster D alone.

Conclusion

COPD patient with severe airflow limitation, many symptoms, and a history of frequent severe exacerbations was a novel and distinct clinical phenotype predicting mortality in men with COPD.

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Abbreviations

AECOPD:

Acute exacerbation of COPD

BMI:

Body mass index

FEV1 :

Forced expiratory volume in one second

mMRC:

Modified Medical Research Council

PCA:

Principal component analysis

SpO2 :

Arterial oxygen saturation

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Acknowledgments

This study was supported by Grants from the National Science Council of Taiwan (NSC 95-2314-B-006-026 and NSC 99-2314-B-006-040.). All authors have no financial interests related to the material in the manuscript.

Conflict of interest

The authors declare that there is no conflict of interest in this study.

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Authors and Affiliations

  1. Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, No. 138, Sheng-Li Rd, Tainan, 704, Taiwan

    Chiung-Zuei Chen, Chih-Ying Ou, Cheng-Hung Lee, Chien-Chung Lin & Tzuen-Ren Hsiue

  2. Department of Public Health, National Cheng Kung University Medical College, Tainan, Taiwan

    Liang-Yi Wang

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  1. Chiung-Zuei Chen
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  2. Liang-Yi Wang
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Correspondence to Tzuen-Ren Hsiue.

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Chen, CZ., Wang, LY., Ou, CY. et al. Using Cluster Analysis to Identify Phenotypes and Validation of Mortality in Men with COPD. Lung 192, 889–896 (2014). https://doi.org/10.1007/s00408-014-9646-x

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  • DOI: https://doi.org/10.1007/s00408-014-9646-x

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