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"High-Risk" Clinical and Inflammatory Clusters in COPD of Chinese Descent.

Abstract：

BACKGROUND:COPD is a heterogeneous disease demonstrating inter-individual variation. A high COPD prevalence in Chinese populations is described, but little is known about disease clusters and prognostic outcomes in the Chinese population across Southeast Asia. We aim to determine if clusters of Chinese patients with COPD exist and their association with systemic inflammation and clinical outcomes. RESEARCH QUESTION:We aim to determine if clusters of Chinese patients with COPD exist and their association with clinical outcomes and inflammation. STUDY DESIGN AND METHODS:Chinese patients with stable COPD were prospectively recruited into two cohorts (derivation and validation) from six hospitals across three Southeast Asian countries (Singapore, Malaysia, and Hong Kong; n = 1,480). Each patient was followed more than 2 years. Clinical data (including co-morbidities) were employed in unsupervised hierarchical clustering (followed by validation) to determine the existence of patient clusters and their prognostic outcome. Accompanying systemic cytokine assessments were performed in a subset (n = 336) of patients with COPD to determine if inflammatory patterns and associated networks characterized the derived clusters. RESULTS:Five patient clusters were identified including: (1) ex-TB, (2) diabetic, (3) low comorbidity: low-risk, (4) low comorbidity: high-risk, and (5) cardiovascular. The cardiovascular and ex-TB clusters demonstrate highest mortality (independent of Global Initiative for Chronic Obstructive Lung Disease assessment) and illustrate diverse cytokine patterns with complex inflammatory networks. INTERPRETATION:We describe clusters of Chinese patients with COPD, two of which represent high-risk clusters. The cardiovascular and ex-TB patient clusters exhibit high mortality, significant inflammation, and complex cytokine networks. Clinical and inflammatory risk stratification of Chinese patients with COPD should be considered for targeted intervention to improve disease outcomes.

journal_name

Chest

journal_title

Chest

authors

Tiew PY,Ko FWS,Narayana JK,Poh ME,Xu H,Neo HY,Loh LC,Ong CK,Mac Aogáin M,Tan JHY,Kamaruddin NH,Sim GJH,Lapperre TS,Koh MS,Hui DSC,Abisheganaden JA,Tee A,Tsaneva-Atanasova K,Chotirmall SH

doi

10.1016/j.chest.2020.01.043

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

145-156

issue

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(20)30326-3

journal_volume

158

pub_type

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"High-Risk" Clinical and Inflammatory Clusters in COPD of Chinese Descent.