title: One-year change in health status and subsequent outcomes in COPD.
abstract: BACKGROUND
  Poor health status has been associated with morbidity and mortality in patients with COPD. To date, the impact of changes in health status on these outcomes remains unknown.
  
  
  OBJECTIVE
  To explore the relationship of clinically relevant changes in health status with exacerbation, hospitalisation or death in patients with COPD.
  
  
  METHODS
  Characteristics and health status (St George's Respiratory Questionnaire, SGRQ) were assessed over a period of 3 years in 2138 patients with COPD enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study: a longitudinal, prospective, observational study. Associations between change in health status (=4 units in SGRQ score) during year 1 and time to first exacerbation, hospitalisation and death during 2-year follow-up were assessed using Kaplan-Meier plots and log-rank test.
  
  
  RESULTS
  1832 (85.7%) patients (age 63.4±7.0 years, 65.4% male, FEV1 48.7±15.6% predicted) underwent assessment at baseline and 1 year. Compared with those who deteriorated, patients with improved or stable health status in year 1 have a lower likelihood of exacerbation (HR 0.78 (95% CI 0.67 to 0.89), p<0.001 and 0.84 (0.73 to 0.97), p=0.016, respectively), hospitalisation (0.72 (0.58 to 0.90), p=0.004 and 0.77 (0.62 to 0.96), p=0.023, respectively) or dying (0.61 (0.39 to 0.95), p=0.027 and 0.58 (0.37 to 0.92), p=0.019, respectively) during 2-year follow-up. This effect persisted after stratification for age and the number of exacerbations and hospitalisations during the first year of the study.
  
  
  CONCLUSIONS
  Patients with stable or improved health status during year 1 of ECLIPSE had a lower likelihood of exacerbation, hospitalisation or dying during 2-year follow-up. Interventions that stabilise and improve health status may also improve outcomes in patients with COPD.
  
  
  BACKGROUND
  NCT00292552, registered at ClinicalTrials.gov.
authors.affiliation: Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wilke
authors.affiliation: Division of Clinical Science, St George's University of London, London, UK.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Jones
authors.affiliation: Respiratory Epidemiology, GlaxoSmithKline, Uxbridge, UK.
authors.forename: H
authors.initials: H
authors.lastname: Müllerova
authors.affiliation: Department of Respiratory Medicine, Gentofte Hospital Hellerup, Gentofte, Denmark Research Group, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation, Manchester, UK.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
authors.affiliation: Research and Development, GlaxoSmithKline, King of Prussia, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tal-Singer
authors.affiliation: Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Frits M E
authors.initials: FM
authors.lastname: Franssen
authors.affiliation: Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona and CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Alvar
authors.initials: A
authors.lastname: Agusti
authors.affiliation: Department of Thoracic Medicine, Institute of Clinical Science, University of Bergen, Haukeland University Hospital, Bergen, Norway.
authors.forename: Per
authors.initials: P
authors.lastname: Bakke
authors.affiliation: Division of Infection and Immunity Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Calverley
authors.affiliation: Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
authors.forename: Harvey O
authors.initials: HO
authors.lastname: Coxson
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Crim
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Edwards
authors.affiliation: Wolfson Institute for Biomedical Research, University College London, London, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Lomas
authors.affiliation: MRC Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edingburgh, UK.
authors.forename: William
authors.initials: W
authors.lastname: MacNee
authors.affiliation: Division of Pulmonary, Critical Care, Sleep & Allergy, University of Nebraska Medical Center, Omaha, USA.
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Rennard
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Yates
authors.affiliation: Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.affiliation: Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands Faculty of Medicine and Life Sciences, REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: COPD Exacerbations