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Predicting Re-Exacerbation Timing and Understanding Prolonged Exacerbations: An Analysis of Patients with COPD in the ECLIPSE Cohort

Authors Meeraus WH, Mullerova H, El Baou C, Fahey M, Hessel EM, Fahy WA

Received 28 August 2020

Accepted for publication 30 December 2020

Published 5 February 2021 Volume 2021:16 Pages 225—244


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Wilhelmine H Meeraus,1 Hana Mullerova,1 Céline El Baou,2 Marion Fahey,1 Edith M Hessel,2 William A Fahy2

1GlaxoSmithKline plc., Epidemiology – Value, Evidence and Outcomes, Middlesex, UK; 2GlaxoSmithKline plc., Research and Development, Middlesex, UK

Correspondence: Wilhelmine H Meeraus
GlaxoSmithKline plc. House, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
Tel +44 208 047 6757

Purpose: Understanding risk factors for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is important for optimizing patient care. We re-analyzed data from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study (NCT00292552) to identify factors predictive of re-exacerbations and associated with prolonged AECOPDs.
Methods: Patients with COPD from ECLIPSE with moderate/severe AECOPDs were included. The end of the first exacerbation was the index date. Timing of re-exacerbation risk was assessed in patients with 180 days’ post-index-date follow-up data. Factors predictive of early (1– 90 days) vs late (91– 180 days) vs no re-exacerbation were identified using a multivariable partial-proportional-odds-predictive model. Explanatory logistic-regression modeling identified factors associated with prolonged AECOPDs.
Results: Of the 1,554 eligible patients from ECLIPSE, 1,420 had 180 days’ follow-up data: more patients experienced early (30.9%) than late (18.7%) re-exacerbations; 50.4% had no re-exacerbation within 180 days. Lower post-bronchodilator FEV1 (P=0.0019), a higher number of moderate/severe exacerbations on/before index date (P< 0.0001), higher St. George’s Respiratory Questionnaire total score (P=0.0036), and season of index exacerbation (autumn vs winter, P=0.00164) were identified as predictors of early (vs late/none) re-exacerbation risk within 180 days. Similarly, these were all predictors of any (vs none) re-exacerbation risk within 180 days. Median moderate/severe AECOPD duration was 12 days; 22.7% of patients experienced a prolonged AECOPD. The odds of experiencing a prolonged AECOPD were greater for severe vs moderate AECOPDs (adjusted odds ratio=1.917, P=0.002) and lower for spring vs winter AECOPDs (adjusted odds ratio=0.578, P=0.017).
Conclusion: Prior exacerbation history, reduced lung function, poorer respiratory-related quality-of-life (greater disease burden), and season may help identify patients who will re-exacerbate within 90 days of an AECOPD. Severe AECOPDs and winter AECOPDs are likely to be prolonged and may require close monitoring.

Keywords: observational study, acute exacerbations of COPD, risk factors, regression modeling

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