title: Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort.
abstract: Comorbidities, are common in COPD, have been associated with poor outcomes and are thought to relate to systemic inflammation. To investigate comorbidities in relation to systemic inflammation and outcomes we recorded comorbidities in a well characterized cohort (ECLIPSE study) for 2164 clinically stable COPD subjects, 337 smokers and 245 non-smokers with normal lung function. COPD patients had a higher prevalence of osteoporosis, anxiety/panic attacks, heart trouble, heart attack, and heart failure, than smokers or nonsmokers. Heart failure (Hazard Ratio [HR] 1.9, 95% Confidence Interval [CI] 1.3-2.9), ischemic heart disease (HR 1.5, 95% CI 1.1-2.0), heart disease (HR 1.5, 95% CI 1.2-2.0), and diabetes (HR 1.7, 95% CI 1.2-2.4) had increased odds of mortality when coexistent with COPD. Multiple comorbidities had accumulative effect on mortality. COPD and cardiovascular disease was associated with poorer quality of life, higher MRC dyspnea scores, reduced 6MWD, higher BODE index scores. Osteoporosis, hypertension and diabetes were associated with higher MRC dyspnea scores and reduced 6MWD. Higher blood concentrations of fibrinogen, IL-6 and IL-8 levels occurred in those with heart disease. Comorbidity is associated with poor clinical outcomes in COPD. The comorbidities of heart disease, hypertension and diabetes are associated with increased systemic inflammation.
authors.affiliation: Queen's Medical Research Institute, University of Edinburgh & Royal Infirmary, Edinburgh, UK.
authors.forename: Joy
authors.initials: J
authors.lastname: Miller
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Edwards
authors.forename: Alvar
authors.initials: A
authors.lastname: Agustí
authors.forename: Per
authors.initials: P
authors.lastname: Bakke
authors.forename: Peter M A
authors.initials: PM
authors.lastname: Calverley
authors.forename: Bartolome
authors.initials: B
authors.lastname: Celli
authors.forename: Harvey O
authors.initials: HO
authors.lastname: Coxson
authors.forename: Courtney
authors.initials: C
authors.lastname: Crim
authors.forename: David A
authors.initials: DA
authors.lastname: Lomas
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Miller
authors.forename: Steve
authors.initials: S
authors.lastname: Rennard
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Silverman
authors.forename: Ruth
authors.initials: R
authors.lastname: Tal-Singer
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
authors.forename: Emiel
authors.initials: E
authors.lastname: Wouters
authors.forename: Julie C
authors.initials: JC
authors.lastname: Yates
authors.forename: William
authors.initials: W
authors.lastname: Macnee
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000401:mortality; D007249:Inflammation / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000401:mortality; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D011656:Pulmonary Emphysema / Q000401:mortality; D012907:Smoking / Q000401:mortality
keywords: Cardiovascular disease; Chronic obstructive pulmonary disease; Cigarette smoking; Diabetes; Emphysema; Osteoporosis