Pei Yee Tiew1, Fanny Wai San Ko2, Jayanth Kumar Narayana3, Mau Ern Poh4, Huiying Xu5, Han Yee Neo5, Li-Cher Loh6, Choo Khoon Ong6, Micheál Mac Aogáin7, Jessica Han Ying Tan8, Nabilah Husna Kamaruddin4, Gerald Jiong Hui Sim9, Therese S Lapperre10, Mariko Siyue Koh11, David Shu Cheong Hui2, John Arputhan Abisheganaden5, Augustine Tee9, Krasimira Tsaneva-Atanasova12, Sanjay H Chotirmall13. 1. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore. 2. Department of Medicine and Therapeutics The Chinese University of Hong Kong, Hong Kong. 3. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Indian Institute of Science Education and Research, Pune, India. 4. Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 5. Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore. 6. Department of Medicine, RCSI-UCD Malaysia Campus, Georgetown, Penang, Malaysia. 7. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. 8. Department of General Medicine, Sengkang General Hospital, Singapore. 9. Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore. 10. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore; Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. 11. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore. 12. Living Systems Institute and Department of Mathematics, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK; PSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, UK. 13. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. Electronic address: schotirmall@ntu.edu.sg.
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.
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.
Authors: Pierre-Régis Burgel; Jean-Louis Paillasseur; Wim Janssens; Jacques Piquet; Gerben Ter Riet; Judith Garcia-Aymerich; Borja Cosio; Per Bakke; Milo A Puhan; Arnulf Langhammer; Inmaculada Alfageme; Pere Almagro; Julio Ancochea; Bartolome R Celli; Ciro Casanova; Juan P de-Torres; Marc Decramer; Andrés Echazarreta; Cristobal Esteban; Rosa Mar Gomez Punter; MeiLan K Han; Ane Johannessen; Bernhard Kaiser; Bernd Lamprecht; Peter Lange; Linda Leivseth; Jose M Marin; Francis Martin; Pablo Martinez-Camblor; Marc Miravitlles; Toru Oga; Ana Sofia Ramírez; Don D Sin; Patricia Sobradillo; Juan J Soler-Cataluña; Alice M Turner; Francisco Javier Verdu Rivera; Joan B Soriano; Nicolas Roche Journal: Eur Respir J Date: 2017-11-02 Impact factor: 16.671
Authors: Alexander Gilkes; Mark Ashworth; Peter Schofield; Timothy H Harries; Stevo Durbaba; Charlotte Weston; Patrick White Journal: Int J Chron Obstruct Pulmon Dis Date: 2016-04-07
Authors: Pei Yee Tiew; Fanny Wai San Ko; Sze Lei Pang; Sri Anusha Matta; Yang Yie Sio; Mau Ern Poh; Kenny J X Lau; Micheál Mac Aogáin; Tavleen Kaur Jaggi; Fransiskus Xaverius Ivan; Nicolas E Gaultier; Akira Uchida; Daniela I Drautz-Moses; Huiying Xu; Mariko Siyue Koh; David Shu Cheong Hui; Augustine Tee; John Arputhan Abisheganaden; Stephan C Schuster; Fook Tim Chew; Sanjay H Chotirmall Journal: Eur Respir J Date: 2020-08-27 Impact factor: 16.671