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‘HIGH RISK’ CLINICAL AND INFLAMMATORY CLUSTERS IN COPD OF CHINESE DESCENT
Chest ( IF 9.5 ) Pub Date : 2020-07-01 , DOI: 10.1016/j.chest.2020.01.043 Pei Yee Tiew 1 , Fanny Wai San Ko 2 , Jayanth Kumar Narayana 3 , Mau Ern Poh 4 , Huiying Xu 5 , Han Yee Neo 5 , Li-Cher Loh 6 , Choo Khoon Ong 6 , Micheál Mac Aogáin 7 , Jessica Han Ying Tan 8 , Nabilah Husna Kamaruddin 4 , Gerald Jiong Hui Sim 9 , Therese S Lapperre 10 , Mariko Siyue Koh 11 , David Shu Cheong Hui 2 , John Arputhan Abisheganaden 5 , Augustine Tee 9 , Krasimira Tsaneva-Atanasova 12 , Sanjay H Chotirmall 7
Chest ( IF 9.5 ) Pub Date : 2020-07-01 , DOI: 10.1016/j.chest.2020.01.043 Pei Yee Tiew 1 , Fanny Wai San Ko 2 , Jayanth Kumar Narayana 3 , Mau Ern Poh 4 , Huiying Xu 5 , Han Yee Neo 5 , Li-Cher Loh 6 , Choo Khoon Ong 6 , Micheál Mac Aogáin 7 , Jessica Han Ying Tan 8 , Nabilah Husna Kamaruddin 4 , Gerald Jiong Hui Sim 9 , Therese S Lapperre 10 , Mariko Siyue Koh 11 , David Shu Cheong Hui 2 , John Arputhan Abisheganaden 5 , Augustine Tee 9 , Krasimira Tsaneva-Atanasova 12 , Sanjay H Chotirmall 7
Affiliation
INTRODUCTION
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 South-East Asia. We aim to determine if clusters of Chinese patients with COPD exist and their association with systemic inflammation and clinical outcomes. METHODS
Chinese patients with stable COPD were prospectively recruited into two cohorts (derivation and validation) from six hospitals across three South-East Asian countries (Singapore, Malaysia and Hong Kong; n=1,480). Each patient was followed over two-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 COPD patients to determine if inflammatory patterns and associated networks characterised the derived clusters. RESULTS
Five patient clusters were identified including (1) Ex-tuberculosis (2) Diabetic (3) Low co-morbidity: low-risk (4) Low co-morbidity: high-risk and (5) cardiovascular. The 'cardiovascular' and 'ex-tuberculosis' clusters demonstrate highest mortality (independent of GOLD assessment) and illustrate diverse cytokine patterns with complex inflammatory networks. CONCLUSIONS
We describe novel 'clusters' of Chinese COPD patients, two of which represent 'high-risk' clusters. The 'cardiovascular' and 'ex-tuberculosis' 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.
更新日期：2020-07-01
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