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. 2014 Oct 3;9(10):e109721.
doi: 10.1371/journal.pone.0109721. eCollection 2014.

Predictors of exacerbations in chronic obstructive pulmonary disease--results from the Bergen COPD cohort study

Gunnar R Husebø  1 , Per S Bakke  2 , Marianne Aanerud  1 , Jon A Hardie  2 , Thor Ueland  3 , Rune Grønseth  1 , Louise J P Persson  1 , Pål Aukrust  3 , Tomas M Eagan  4
Affiliations

Predictors of exacerbations in chronic obstructive pulmonary disease--results from the Bergen COPD cohort study

Gunnar R Husebø et al. PLoS One. .

Abstract

Background: COPD exacerbations accelerate disease progression.

Aims: To examine if COPD characteristics and systemic inflammatory markers predict the risk for acute COPD exacerbation (AECOPD) frequency and duration.

Methods: 403 COPD patients, GOLD stage II-IV, aged 44-76 years were included in the Bergen COPD Cohort Study in 2006/07, and followed for 3 years. Examined baseline predictors were sex, age, body composition, smoking, AECOPD the last year, GOLD stage, Charlson comorbidity score (CCS), hypoxemia (PaO2<8 kPa), cough, use of inhaled steroids, and the inflammatory markers leucocytes, C-reactive protein (CRP), neutrophil gelatinase associated lipocalin (NGAL), soluble tumor necrosis factor receptor 1 (sTNF-R1), and osteoprotegrin (OPG). Negative binomial models with random effects were fitted to estimate the annual incidence rate ratios (IRR). For analysis of AECOPD duration, a generalized estimation equation logistic regression model was fitted, also adjusting for season, time since inclusion and AECOPD severity.

Results: After multivariate adjustment, significant predictors of AECOPD were: female sex [IRR 1.45 (1.14-1.84)], age per 10 year increase [1.23 (1.03-1.47)], >1 AECOPD last year before baseline [1.65 (1.24-2.21)], GOLD III [1.36 (1.07-1.74)], GOLD IV [2.90 (1.98-4.25)], chronic cough [1.64 (1.30-2.06)] and use of inhaled steroids [1.57 (1.21-2.05)]. For AECOPD duration more than three weeks, significant predictors after adjustment were: hypoxemia [0.60 (0.39-0.92)], years since inclusion [1.19 (1.03-1.37)], AECOPD severity; moderate [OR 1.58 (1.14-2.18)] and severe [2.34 (1.58-3.49)], season; winter [1.51 (1.08-2.12)], spring [1.45 (1.02-2.05)] and sTNF-R1 per SD increase [1.16 (1.00-1.35)].

Conclusion: Several COPD characteristics were independent predictors of both AECOPD frequency and duration.

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Conflict of interest statement

Competing Interests: PSB has within the last 5 years received lecture fees from GlaxoSmithKline, Pfizer, Novartis, AstraZeneca, and Boehringer Ingelheim, and received research grants from GlaxoSmithKline and Novartis, MAa has within the last 5 years received lecture fees from GlaxoSmithKline, Boehringer Ingelheim, and AstraZeneca, RG reports grants from The Norwegian Association of Heart and Lung Patients and EXTRA funds from the Norwegian Foundation for Health and Rehabilitation; grants from Boehringer Ingelheim, personal fees from GlaxoSmithKline; and travel grants from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim and Pfizer, TME has within the last 5 years received lecture fees from GlaxoSmithKline and Boehringer Ingelheim, and received travel grants from InterMune. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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