Introduction
Methods
Subjects
Pulmonary function and blood gas analysis
Clinical and biochemical examinations
Statistical analysis
Results
Characteristics of the patients in the study population I
Characteristic | Total | COPD without pulmonary hypertension | COPD with pulmonary hypertension | P-value |
---|---|---|---|---|
Number | 937 | 758 | 179 | |
Age (year) | 65.00 (58.00–71.00) | 65.00 (58.00–71.00) | 68.00 (61.00–73.00) | 0.000 |
Male (%) | 77.6 | 75.7 | 85.5 | 0.005 |
Body mass index | 23.63 ± 3.92 | 23.69 ± 3.87 | 22.34 ± 3.89 | 0.000 |
Smoking index (pack-year) | 20.00 (0.00–40.00) | 20.00 (0.00–40.00) | 30.00 (9.00–40.00) | 0.029 |
Smoking status | ||||
Never (%) | 33.3 | 35.8 | 22.9 | |
Former (%) | 30.3 | 28.9 | 36.3 | |
Current (%) | 36.4 | 35.4 | 40.8 | |
Comorbidity | ||||
Hypertension (%) | 28.1 | 27.7 | 29.6 | 0.610 |
Diabetes (%) | 6.7 | 6.5 | 7.8 | 0.515 |
Coronary heart disease (%) | 22.1 | 17.8 | 40.2 | 0.000 |
Inhalation therapy | ||||
SABD (%) | 2.7 | 2.4 | 3.9 | 0.955 |
ICS/LABA (%) | 28.8 | 29.6 | 25.7 | 0.306 |
ICS/LABA + LAMA (%) | 29.2 | 29.6 | 27.9 | 0.669 |
LAMA (%) | 22.9 | 22.0 | 26.8 | 0.092 |
FEV1 (L) | 1.14 (0.81–1.54) | 1.18 (0.86–1.58) | 0.87 (0.69–1.33) | 0.000 |
FEV1 (% predicted) | 45.60 (31.90–62.90) | 48.00 (34.00–65.73) | 34.90 (27.20–53.30) | 0.000 |
FVC (L) | 2.50 (2.00–3.06) | 2.56 (2.03–3.12) | 2.33 (1.90–2.70) | 0.000 |
FVC (% predicted) | 79.13 ± 21.22 | 80.74 ± 21.51 | 72.28 ± 18.53 | 0.000 |
FEV1/FVC (%) | 46.37 (37.58–57.87) | 47.54 (38.80–58.41) | 41.08 (33.90–52.85) | 0.000 |
VA (L) | 4.91 ± 1.06 | 4.95 ± 1.07 | 4.79 ± 1.02 | 0.070 |
VA (% predicted) | 86.55 ± 14.53 | 87.42 ± 14.31 | 82.85 ± 14.95 | 0.000 |
DLCO (mmol/min/kPa) | 5.81 ± 2.36 | 6.14 ± 2.32 | 4.42 ± 2.00 | 0.000 |
DLCO (% predicted) | 73.45 ± 27.80 | 77.25 ± 26.66 | 57.39 ± 26.87 | 0.000 |
FVC/DLCO (l/mmol/min/kPa) | 0.44 (0.35–0.56) | 0.42 (0.34–0.53) | 0.51 (0.41–0.76) | 0.000 |
FVC%/DLCO% | 1.06 (0.87–1.38) | 1.03 (0.84–1.30) | 1.26 (0.99–1.82) | 0.000 |
LVEF (%) | 67.00 (63.00–71.50) | 67.00 (63.00–71.00) | 67.00 (63.00–72.00) | 0.427 |
LVFS (%) | 37.00 (34.00–41.00) | 37.00 (34.00–41.00) | 37.00 (34.00–42.00) | 0.539 |
pH | 7.42 ± 0.03 | 7.43 ± 0.03 | 7.42 ± 0.04 | 0.002 |
PaO2 (mmHg) | 70.80 (63.60–78.00) | 71.60 (65.18–78.53) | 66.50 (58.30–76.00) | 0.000 |
PaCO2 (mmHg) | 38.90 (35.60–42.70) | 38.50 (35.20–42.00) | 40.80 (36.60–47.90) | 0.000 |
PO2(A-a) (mmHg) | 27.10 (19.85–34.30) | 26.90 (20.00–33.70) | 28.00 (19.20–37.30) | 0.246 |
Leukocyte count (× 109/L) | 6.42 (5.11–8.22) | 6.38 (5.12–8.13) | 6.71 (5.02–8.73) | 0.369 |
Neutrophil count (× 109/L) | 4.21 (3.13–5.94) | 4.13 (3.11–5.80) | 4.49 (3.29–6.57) | 0.024 |
Platelet count (× 109/L) | 181.00 (142.00–222.50) | 183.00 (146.75–223.00) | 172.00 (133.00–215.00) | 0.054 |
Hemoglobin (g/L) | 137.00 (125.00–146.00) | 136.00 (125.00–146.00) | 137.00 (125.00–148.00) | 0.289 |
Albumin (g/L) | 39.48 ± 3.99 | 39.66 ± 3.92 | 38.71 ± 4.19 | 0.004 |
Globulin (g/L) | 24.79 ± 4.42 | 24.86 ± 4.30 | 24.53 ± 4.88 | 0.407 |
ALT (IU/L) | 17.00 (12.00–25.00) | 17.00 (12.00–25.25) | 16.00 (12.00–24.00) | 0.548 |
AST (IU/L) | 19.00 (16.00–25.00) | 19.00 (16.00–24.00) | 20.00 (16.00–26.00) | 0.060 |
DBIL (μmol/L) | 4.41 (3.28–6.00) | 4.40 (3.30–5.90) | 4.70 (3.20–6.30) | 0.261 |
IBIL (μmol/L) | 6.97 (4.89–9.47) | 6.90 (4.87–9.38) | 7.10 (5.00–9.90) | 0.143 |
Creatinine (μmol/L) | 69.41 (59.33–81.00) | 68.74 (58.80–80.33) | 73.01 (62.00–83.00) | 0.021 |
BUN (mmol/L) | 5.08 (4.10–6.23) | 4.99 (4.09–6.08) | 5.45 (4.26–6.63) | 0.009 |
Cystatin C (mg/L) | 0.99 (0.86–1.13) | 0.97 (0.85–1.11) | 1.02 (0.88–1.20) | 0.003 |
D-dimer (ng/mL) | 360.00 (205.00–625.00) | 340.00 (200.00–610.00) | 430.00 (210.00–710.00) | 0.052 |
Factors associated with COPD combined with PH
Variable | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | |
Age (per increase of 1-year) | 1.04 (1.02–1.06) | 0.000 | 1.03 (1.00–1.06) | 0.021 |
Sex (female vs male) | 0.53 (0.34–0.83) | 0.005 | 0.89 (0.52–1.53) | 0.676 |
Body mass index (per increase of 1 point) | 0.91 (0.87–0.95) | 0.000 | 0.94 (0.89–0.99) | 0.019 |
Smoking index (pack-year) | 1.00 (0.99–1.01) | 0.202 | ||
FEV1 (% predicted) | 0.97 (0.96–0.98) | 0.000 | 0.98 (0.97–1.00) | 0.080 |
FVC (% predicted) | 0.98 (0.97–0.99) | 0.000 | 0.99 (0.98–1.01) | 0.647 |
VA (% predicted) | 0.97 (0.96–0.98) | 0.000 | 1.01 (0.99–1.02) | 0.528 |
DLCO (% predicted) (≥ 80 vs < 80%) | 3.14 (2.13–4.63) | 0.000 | 1.03 (0.59–1.80) | 0.911 |
FVC/DLCO (≥ 0.44 vs < 0.44 l/mmol/min/kPa) | 2.56 (1.18–3.62) | 0.000 | 2.11 (1.30–3.45) | 0.003 |
Hypertension (yes vs no) | 1.10 (0.77–1.57) | 0.610 | ||
Diabetes (yes vs no) | 1.23 (0.66–2.28) | 0.515 | ||
Coronary heart disease (yes vs no) | 3.11 (2.18–4.12) | 0.000 | 3.23 (2.15–4.84) | 0.000 |
SABD (yes vs no) | 1.18 (0.43–3.23) | 0.745 | ||
ICS/LABA (yes vs no) | 0.83 (0.57–1.19) | 0.306 | ||
ICS/LABA + LAMA (yes vs no) | 0.92 (0.64–1.33) | 0.669 | ||
LAMA (yes vs no) | 1.37 (0.95–1.98) | 0.093 | ||
pH (≥ 7.4 vs < 7.4) | 0.54 (0.37–0.78) | 0.001 | 0.91 (0.57–1.45) | 0.701 |
PaO2 (≥ 60 vs < 60 mmHg) | 3.47 (2.36–5.10) | 0.000 | 1.76 (1.10–2.82) | 0.019 |
PaCO2 (≥ 50 vs < 50 mmHg) | 4.50 (2.70–7.50) | 0.000 | 3.13 (1.57–6.23) | 0.001 |
Neutrophil count (per increase of 1 × 109/L) | 1.11 (1.04–1.18) | 0.002 | 1.07 (0.99–1.15) | 0.063 |
Albumin (per increase of 1 standard deviation g/L) | 0.94 (0.91–0.98) | 0.005 | 1.01 (0.96–1.06) | 0.726 |
Creatinine (per increase of 1 standard deviation μmol/L) | 1.01 (1.00–1.02) | 0.052 | ||
BUN (per increase of 1 standard deviation mmol/L) | 1.15 (1.06–1.26) | 0.001 | 1.04 (0.94–1.15) | 0.480 |
Cystatin C (per increase of 1standard deviation mg/L) | 3.03 (1.64–5.61) | 0.000 | 1.97 (0.94–4.13) | 0.073 |
Characteristics of the patients in the study population II
Characteristic | Total | Non-survivors | Survivors | P-value |
---|---|---|---|---|
Number | 750 | 122 | 628 | |
Age (year) | 65.00 (58.00–71.00) | 68.50 (61.75–74.00) | 64.00 (58.00–71.00) | 0.000 |
Male (%) | 77.2 | 82.8 | 76.1 | 0.108 |
Body mass index | 23.63 ± 3.92 | 21.93 ± 3.85 | 23.96 ± 3.85 | 0.000 |
Smoking index (pack-yr.) | 20.00 (0.00–40.00) | 30.00 (0.00–45.00) | 20.00 (0.00–40.00) | 0.033 |
Smoking status | ||||
Never (%) | 33.1 | 26.2 | 34.4 | |
Former (%) | 30.5 | 34.4 | 29.8 | |
Current (%) | 36.4 | 39.3 | 35.8 | |
Comorbidity | ||||
Hypertension (%) | 28.8 | 36.1 | 27.4 | 0.053 |
Diabetes (%) | 6.9 | 7.4 | 6.8 | 0.833 |
Coronary heart disease (%) | 21.6 | 28.7 | 20.2 | 0.038 |
Pulmonary hypertension (%) | 17.1 | 33.6 | 13.9 | 0.000 |
Inhalation therapy | ||||
SABD (%) | 2.7 | 4.1 | 2.4 | 0.444 |
ICS/LABA (%) | 28.1 | 25.4 | 28.7 | 0.465 |
ICS/LABA + LAMA (%) | 28.8 | 22.1 | 30.1 | 0.075 |
LAMA (%) | 25.5 | 32.0 | 24.2 | 0.072 |
FEV1 (L) | 1.16 (0.83–1.55) | 0.88 (0.71–1.21) | 1.22 (0.87–1.62) | 0.000 |
FEV1 (% predicted) | 46.50 (32.48–63.45) | 34.35 (27.10–49.98) | 48.65 (35.15–66.18) | 0.000 |
FVC (L) | 2.51 (2.03–3.08) | 2.27 (1.80–2.65) | 2.59 (2.09–3.16) | 0.000 |
FVC (% predicted) | 79.96 ± 21.11 | 72.42 ± 20.28 | 81.43 ± 20.97 | 0.000 |
FEV1/FVC (%) | 46.99 (37.93–58.15) | 41.19 (32.83–53.72) | 48.48 (39.10–58.50) | 0.000 |
VA (L) | 4.93 ± 1.07 | 4.68 ± 0.99 | 4.98 ± 1.08 | 0.004 |
VA (% predicted) | 87.02 ± 14.55 | 82.20 ± 15.06 | 87.95 ± 14.27 | 0.000 |
DLCO (mmol/min/kPa) | 5.89 (4.41–7.39) | 4.12 (3.24–5.45) | 6.18 (4.74–7.70) | 0.000 |
DLCO (% predicted) | 75.41 ± 27.54 | 56.16 ± 24.53 | 79.15 ± 26.53 | 0.000 |
FVC/DLCO (l/mmol/min/kPa) | 0.42 (0.34–0.54) | 0.52 (0.41–0.71) | 0.41 (0.33–0.52) | 0.000 |
FVC%/DLCO% | 1.04 (0.85–1.33) | 1.26 (1.00–1.65) | 1.01 (0.83–1.26) | 0.000 |
LVEF (%) | 67.00 (62.75–71.00) | 66.00 (61.00–71.25) | 67.00 (63.00–71.00) | 0.104 |
LVFS (%) | 37.00 (34.00–41.00) | 37.00 (33.00–42.00) | 37.00 (34.00–41.00) | 0.789 |
pH | 7.43 ± 0.03 | 7.42 ± 0.04 | 7.43 ± 0.03 | 0.619 |
PaO2 (mmHg) | 71.56 ± 13.29 | 66.48 ± 14.86 | 72.55 ± 12.74 | 0.000 |
PaCO2 (mmHg) | 38.80 (35.58–42.40) | 39.95 (36.25–46.58) | 38.55 (35.40–41.70) | 0.001 |
PO2(A-a) (mmHg) | 26.90 (19.70–33.83) | 27.70 (20.85–38.70) | 26.70 (19.60–33.60) | 0.031 |
Leukocyte count (× 109/L) | 6.51 (5.18–8.25) | 6.66 (5.32–8.21) | 6.45 (5.16–8.27) | 0.650 |
Neutrophil count (× 109/L) | 4.22 (3.16–5.98) | 4.52 (3.42–6.39) | 4.16 (3.10–5.84) | 0.039 |
Platelet count (× 109/L) | 179.00 (141.00–226.00) | 166.50 (135.50–210.50) | 182.00 (143.25–227.00) | 0.083 |
Hemoglobin (g/L) | 135.86 ± 16.96 | 133.66 ± 19.93 | 136.29 ± 16.30 | 0.118 |
Albumin (g/L) | 39.80 (37.00–42.40) | 38.05 (35.60–40.80) | 40.00 (37.30–42.60) | 0.000 |
Globulin (g/L) | 24.84 ± 4.39 | 25.25 ± 4.96 | 24.75 ± 4.27 | 0.305 |
ALT (IU/L) | 17.00 (12.00–25.00) | 15.08 (11.00–22.00) | 17.00 (12.00–26.00) | 0.046 |
AST (IU/L) | 19.00 (16.00–25.00) | 20.00 (15.00–26.00) | 19.00 (16.00–24.96) | 0.663 |
DBIL (μmol/L) | 4.50 (3.36–6.00) | 4.65 (3.25–6.44) | 4.42 (3.40–5.91) | 0.295 |
IBIL (μmol/L) | 6.87 (4.79–9.43) | 6.62 (4.57–9.84) | 6.90 (4.88–9.40) | 0.587 |
Creatinine (μmol/L) | 68.93 (58.67–80.33) | 69.13 (59.37–81.77) | 68.72 (58.67–80.28) | 0.624 |
BUN (mmol/L) | 5.10 (4.11–6.19) | 5.24 (4.28–6.36) | 5.08 (4.05–6.12) | 0.135 |
Cystatin C (mg/L) | 0.99 (0.86–1.13) | 1.04 (0.89–1.21) | 0.98 (0.85–1.11) | 0.007 |
D-dimer (ng/mL) | 360.00 (210.00–620.00) | 461.50 (270.00–742.50) | 330.00 (210.00–600.00) | 0.002 |
Factors associated with 5-year all-cause mortality in COPD patients
Variable | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
HR (95%CI) | P-value | HR (95%CI) | P-value | |
Age (per increase of 1-year) | 1.05 (1.02–1.07) | 0.000 | 1.04 (1.01–1.07) | 0.007 |
Sex (female vs male) | 0.69 (0.43–1.10) | 0.121 | ||
Body mass index (per increase of 1 point) | 0.88 (0.84–0.92) | 0.000 | 0.93 (0.88–0.98) | 0.011 |
Smoking index (pack-year) | 1.00 (0.99–1.01) | 0.077 | ||
FEV1 (% predicted) | 0.97 (0.96–0.98) | 0.000 | 0.99 (0.97–1.01) | 0.268 |
FVC (% predicted) | 0.98 (0.97–0.99) | 0.000 | 1.00 (0.98–1.02) | 0.712 |
VA (% predicted) | 0.97(0.96–0.99) | 0.000 | 1.00 (0.98–1.01) | 0.518 |
DLCO (% predicted) (≥ 80 vs < 80%) | 4.50 (2.76–7.34) | 0.000 | 1.37 (0.73–2.58) | 0.323 |
FVC/DLCO (≥ 0.41 vs < 0.41 l/mmol/min/kPa) | 3.33 (2.16–5.13) | 0.000 | 2.05 (1.19–3.53) | 0.009 |
Hypertension (yes vs no) | 1.47 (1.02–2.24) | 0.041 | 1.65 (1.09–2.49) | 0.017 |
Diabetes (yes vs no) | 1.07 (0.54–2.11) | 0.840 | ||
Coronary heart disease (yes vs no) | 1.51 (1.02–2.24) | 0.038 | 1.13 (0.74–1.73) | 0.572 |
Pulmonary hypertension (yes vs no) | 2.87 (1.97–4.17) | 0.000 | 1.68 (1.12–2.53) | 0.012 |
SABD (yes vs no) | 1.70 (0.70–4.16) | 0.245 | ||
ICS/LABA (yes vs no) | 0.86 (0.57–1.29) | 0.461 | ||
ICS/LABA + LAMA (yes vs no) | 0.69 (0.45–1.05) | 0.083 | ||
LAMA (yes vs no) | 1.40 (0.95–2.04) | 0.086 | ||
pH (≥ 7.4 vs < 7.4) | 0.62 (0.42–0.93) | 0.020 | 0.91 (0.57–1.45) | 0.686 |
PaO2 (≥ 60 vs < 60 mmHg) | 2.76 (1.88–4.06) | 0.000 | 1.27 (0.81–2.00) | 0.306 |
PaCO2 (≥ 50 vs < 50 mmHg) | 3.34 (2.04–5.45) | 0.000 | 2.02 (1.08–3.78) | 0.028 |
Neutrophil count (per increase of 1 × 109/L) | 1.09 (1.02–1.16) | 0.014 | 1.03 (0.97–1.09) | 0.404 |
Albumin (per increase of 1 standard deviation g/L) | 0.89 (0.85–0.93) | 0.000 | 0.93 (0.89–0.97) | 0.002 |
ALT (per increase of 1 standard deviation IU/L) | 1.00 (0.99–1.01) | 0.983 | ||
Cystatin C (per increase of 1standard deviation mg/L) | 2.36 (1.30–4.29) | 0.005 | 1.22 (0.62–2.38) | 0.569 |
D-dimer (per increase of 1standard deviation ng/mL) | 1.00 (1.00–1.00) | 0.476 |