Sex-specific associations of comorbidome and pulmorbidome with mortality in chronic obstructive pulmonary disease: results from COSYCONET
Franziska Trudzinski, Rudolf A. Jörres, Peter Alter, Julia Walter, Henrik Watz, Andrea Koch, Matthias John, Marek Lommatzsch, Claus Vogelmeier, Hans‐Ulrich Kauczor, Tobias Welte, Jürgen Behr, Amanda Tufman, Robert Bals, Felix Herth, Kathrin Kahnert, The COSYCONET Study Group, Andreas Stefan, Robert Bals, Jürgen Behr, Kathrin Kahnert, Burkhard Bewig, Roland Buhl, Ralf Ewert, Beate Stubbe, Joachim H. Ficker, Gogol Manfred, Christian Grohé, Hauck Rainer, Matthias Held, B. Jany, Markus Henke, Felix Herth, Höffken Gerd, Hugo A. Katus, Anne‐Marie Kirsten, Henrik Watz, Rembert Koczulla, Klaus Kenn, Juliane Kronsbein, Cornelia Kropf-Sanchen, Lange Christoph, P. Zabel, Michael Pfeifer, Winfried Randerath, Werner Seeger, Michael Studnicka, Christian Taube, Teschler Helmut, Hartmut Timmermann, J. Christian Virchow, Claus Vogelmeier, Wagner Ulrich, Tobias Welte, Hubert Wirtz
Abstract
In patients with COPD, it has not been comprehensively assessed whether the predictive value of comorbidities for mortality differs between men and women. We therefore aimed to examine sex differences of COPD comorbidities in regard with prognosis by classifying comorbidities into a comorbidome related to extrapulmonary disorders and a pulmorbidome, referring to pulmonary disorders. The study population comprised 1044 women and 1531 men with the diagnosis of COPD from COSYCONET, among them 2175 of GOLD grades 1-4 and 400 at risk. Associations of comorbidities with mortality were studied using Cox regression analysis for men and women separately. During the follow-up (median 3.7 years) 59 women and 159 men died. In men, obesity, hypertension, coronary artery disease, liver cirrhosis, osteoporosis, kidney disease, anaemia and increased heart rate (HR) predict mortality, in women heart failure, hyperuricemia, mental disorders, kidney disease and increased HR (p < 0.05 each). Regarding the pulmorbidome, significant predictors in men were impairment in diffusion capacity and hyperinflation, in women asthma and hyperinflation. Similar results were obtained when repeating the analyses in GOLD 1-4 patients only. Gender differences should be considered in COPD risk assessment for a tailored approach towards the treatment of COPD.Clinical Trial Registration: ClinicalTrials.gov NCT01245933.