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The Capital Region of Denmark - a part of Copenhagen University Hospital
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"High-Risk" Clinical and Inflammatory Clusters in COPD of Chinese Descent

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  • Pei Yee Tiew
  • Fanny Wai San Ko
  • Jayanth Kumar Narayana
  • Mau Ern Poh
  • Huiying Xu
  • Han Yee Neo
  • Li-Cher Loh
  • Choo Khoon Ong
  • Micheál Mac Aogáin
  • Jessica Han Ying Tan
  • Nabilah Husna Kamaruddin
  • Gerald Jiong Hui Sim
  • Therese S Lapperre
  • Mariko Siyue Koh
  • David Shu Cheong Hui
  • John Arputhan Abisheganaden
  • Augustine Tee
  • Krasimira Tsaneva-Atanasova
  • Sanjay H Chotirmall
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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.

Original languageEnglish
JournalChest
Volume158
Issue number1
Pages (from-to)145-156
Number of pages12
ISSN0012-3692
DOIs
Publication statusPublished - Jul 2020

    Research areas

  • cardiovascular, Chinese, COPD, mortality, TB

ID: 60307864