The clinical phenotype of acute exacerbation of chronic obstructive pulmonary disease by cluster analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

FEI Fan , WU Zhenzhen , ZHU Manni , CHENG Luxiao , ZHOU Lianzheng , MA Yuan , JI Ningfei ,  HUANG Mao

Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P. R. China;

Corresponding?author：

HUANG Mao, Email: hm6114@126.com

Keywords：

Chronic obstructive pulmonary disease; Acute exacerbation; Phenotype; Individualized treatment

DOI：

10.7507/1671-6205.201812066

Video：

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Objective To explore the clinical phenotype of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) by cluster analysis and provide a basis for individualized treatment.Methods A total of 515 patients with acute exacerbation of COPD admitted to this department from January 2014 to December 2016 were enrolled. The age, duration, smoking index, number of hospitalizations in the past 1 year, hospitalization days, treatment costs and other information were collected for cluster analysis.Results The patients were divided into three categories of phenotype: " mild-glucocorticoid resistance-antibiotic dependent”," mild-glucocorticoid sensitive”, and " serious complication”. The patients with the first two phenotypes had a milder condition and lower hospitalization costs. There were differences in the time and cumulative dose of glucocorticoids in different pathways, antibiotic use time and usage rate. The third phenotype was the most serious, with the highest cost of hospitalization, and may merge or co-exist with other diseases such as cardiovascular disease and digestive tract disease.Conclusion Cluster analysis may identify different phenotypes of acute exacerbation of COPD to provide a reference for clinical individualized treatment.

Citation： FEI Fan, WU Zhenzhen, ZHU Manni, CHENG Luxiao, ZHOU Lianzheng, MA Yuan, JI Ningfei, HUANG Mao. The clinical phenotype of acute exacerbation of chronic obstructive pulmonary disease by cluster analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(4): 309-313. doi: 10.7507/1671-6205.201812066 Copy

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2.	Han MK, Quibrera PM, Carretta EE, et al. Frequency of exacerbations in patients with chronic obstructive pulmonary disease: an analysis of the SPIROMICS cohort. Lancet Respir Med, 2017, 5(8): 619-626.
3.	Donaldson GC, Müllerova H, Locantore N, et al. Factors associated with change in exacerbation frequency in COPD. Respir Res, 2013, 14(1): 79.
4.	MacDonald M, Beasley RW, Irving L, et al. A hypothesis to phenotype COPD exacerbations by aetiology. Respirology, 2011, 16(2): 264-268.
5.	Weatherall M, Travers J, Shirtcliffe PM, et al. Distinct clinical phenotypes of airways disease defined by cluster analysis. Eur Respir J, 2009, 34(4): 812-818.
6.	Burgel PR, Paillasseur JL, Caillaud D, et al. Clinical COPD phenotypes: a novel approach using principal component and cluster analyses. Eur Respir J, 2010, 36(3): 531-539.
7.	Wardlaw AJ, Silverman M, Siva R, et al. Multi-dimensional phenotyping: towards a new taxonomy for airway disease. Clin Exp Allergy, 2005, 35(10): 1254-1262.
8.	Miravitlles M, Soler-Catalu?a JJ, Calle M, et al. A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD Guidelines (GesEPOC). Prim Care Respir J, 2013, 22(1): 117-121.
9.	魏丹丹, 白澎, 孫永昌. 聚類分析在慢性阻塞性肺疾病表型研究中的應用探討. 中國呼吸與危重監護雜志, 2012, 11(5): 417-421.
10.	寧璞, 郭巖斐, 孫鐵英, 等. 系統聚類分析探討老年人呼吸道疾病的臨床表型. 中華老年醫學雜志, 2016, 35(3): 256-259.
11.	Alotaibi NM, Chen V, Hollander Z, et al. Phenotyping COPD exacerbations using imaging and blood-based biomarkers. Int J Chron Obstruct Pulmon Dis, 2018, 13: 217-229.
12.	Noell G, Cosio BG, Faner R, et al. Multi-level differential network analysis of COPD exacerbations. Eur Respir J, 2017, 50(3): pii: 1700075.
13.	Mathioudakis AG, Chatzimavridou-Grigoriadou V, Corlatean A, et al. Procalcitonin to guide antibiotic administration in COPD exacerbations: a meta-analysis. Eur Respir Rev, 2017, 26(143): pii: 160073.
14.	Zhou A, Zhou Z, Zhao Y, et al. The recent advances of phenotypes in acute exacerbations of COPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1009-1018.
15.	Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med, 1987, 106(2): 196-204.
16.	Bafadhel M, Mckenna S, Terry S, et al. Acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2011, 184(6): 662-671.
17.	Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med, 2006, 173(10): 1114-1121.
18.	Sethi S, Maloney J, Grove L, et al. Airway inflammation and bronchial bacterial colonization in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2006, 173(9): 991-998.
19.	Sethi S, Wrona C, Eschberger K, et al. Inflammatory profile of new bacterial strain exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2008, 177(5): 491-497.
20.	Wilkinson TM, Hurst JR, Perera WR, et al. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest, 2006, 129(2): 317-324.
21.	Mueller C, Laule-Kilian K, Frana B, et al. Use of B-type natriuretic peptide in the management of acute dyspnea in patients with pulmonary disease. Am Heart J, 2006, 151(2): 471-477.
22.	McCullough PA, Hollander JE, Nowak RM, et al. Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. Acad Emerg Med, 2003, 10(3): 198-204.
23.	Mohan A, Chandra S, Agarwal D, et al. Prevalence of viral infection detected by PCR and RT-PCR in patients with acute exacerbation of COPD: a systematic review. Respirology, 2010, 15(3): 536-542.
24.	Perera WR, Hurst JR, Wilkinson TM, et al. Inflammatory changes, recovery and recurrence at COPD exacerbation. Eur Respir J, 2007, 29(3): 527-534.

1. Global Initiative for Chronic Oobstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Ibstructive Pulmonary Disease 2018 Report. Available at: https://goldcopd.org/.
2. Han MK, Quibrera PM, Carretta EE, et al. Frequency of exacerbations in patients with chronic obstructive pulmonary disease: an analysis of the SPIROMICS cohort. Lancet Respir Med, 2017, 5(8): 619-626.
3. Donaldson GC, Müllerova H, Locantore N, et al. Factors associated with change in exacerbation frequency in COPD. Respir Res, 2013, 14(1): 79.
4. MacDonald M, Beasley RW, Irving L, et al. A hypothesis to phenotype COPD exacerbations by aetiology. Respirology, 2011, 16(2): 264-268.
5. Weatherall M, Travers J, Shirtcliffe PM, et al. Distinct clinical phenotypes of airways disease defined by cluster analysis. Eur Respir J, 2009, 34(4): 812-818.
6. Burgel PR, Paillasseur JL, Caillaud D, et al. Clinical COPD phenotypes: a novel approach using principal component and cluster analyses. Eur Respir J, 2010, 36(3): 531-539.
7. Wardlaw AJ, Silverman M, Siva R, et al. Multi-dimensional phenotyping: towards a new taxonomy for airway disease. Clin Exp Allergy, 2005, 35(10): 1254-1262.
8. Miravitlles M, Soler-Catalu?a JJ, Calle M, et al. A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD Guidelines (GesEPOC). Prim Care Respir J, 2013, 22(1): 117-121.
9. 魏丹丹, 白澎, 孫永昌. 聚類分析在慢性阻塞性肺疾病表型研究中的應用探討. 中國呼吸與危重監護雜志, 2012, 11(5): 417-421.
10. 寧璞, 郭巖斐, 孫鐵英, 等. 系統聚類分析探討老年人呼吸道疾病的臨床表型. 中華老年醫學雜志, 2016, 35(3): 256-259.
11. Alotaibi NM, Chen V, Hollander Z, et al. Phenotyping COPD exacerbations using imaging and blood-based biomarkers. Int J Chron Obstruct Pulmon Dis, 2018, 13: 217-229.
12. Noell G, Cosio BG, Faner R, et al. Multi-level differential network analysis of COPD exacerbations. Eur Respir J, 2017, 50(3): pii: 1700075.
13. Mathioudakis AG, Chatzimavridou-Grigoriadou V, Corlatean A, et al. Procalcitonin to guide antibiotic administration in COPD exacerbations: a meta-analysis. Eur Respir Rev, 2017, 26(143): pii: 160073.
14. Zhou A, Zhou Z, Zhao Y, et al. The recent advances of phenotypes in acute exacerbations of COPD. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1009-1018.
15. Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med, 1987, 106(2): 196-204.
16. Bafadhel M, Mckenna S, Terry S, et al. Acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2011, 184(6): 662-671.
17. Papi A, Bellettato CM, Braccioni F, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med, 2006, 173(10): 1114-1121.
18. Sethi S, Maloney J, Grove L, et al. Airway inflammation and bronchial bacterial colonization in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2006, 173(9): 991-998.
19. Sethi S, Wrona C, Eschberger K, et al. Inflammatory profile of new bacterial strain exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2008, 177(5): 491-497.
20. Wilkinson TM, Hurst JR, Perera WR, et al. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest, 2006, 129(2): 317-324.
21. Mueller C, Laule-Kilian K, Frana B, et al. Use of B-type natriuretic peptide in the management of acute dyspnea in patients with pulmonary disease. Am Heart J, 2006, 151(2): 471-477.
22. McCullough PA, Hollander JE, Nowak RM, et al. Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. Acad Emerg Med, 2003, 10(3): 198-204.
23. Mohan A, Chandra S, Agarwal D, et al. Prevalence of viral infection detected by PCR and RT-PCR in patients with acute exacerbation of COPD: a systematic review. Respirology, 2010, 15(3): 536-542.
24. Perera WR, Hurst JR, Wilkinson TM, et al. Inflammatory changes, recovery and recurrence at COPD exacerbation. Eur Respir J, 2007, 29(3): 527-534.

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