Affiliations 

  • 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
Chest, 2020 Jul;158(1):145-156.
PMID: 32092320 DOI: 10.1016/j.chest.2020.01.043

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.