Mortality in a cohort of COPD patients according to their clinical phenotype

Introduction: COPD is a prevalent and underdiagnosed disease. It had been suggested that grouping COPD patients in phenotypes(PTP) according to their attributes might be useful for their management and prognosis. Our aim was to assess the mortality in our COPD patients according to their clinical phenotype Methods: Observational study of 756 confirmed COPD patients with a prospective follow-up in a COPD clinic from 2009 to 2019. They were classified into PTP: non-exacerbator(NONEX), emphysematous exacerbator(EMPEX), chronic bronchitis exacerbator(CBEX) and asthma-COPD-overlap(ACO). Mortality was analyzed in 2024(15 years of follow-up). Functional and clinical variables were collected Results: 66% were men with a mean age of 75,5±8,9 years. Distribution according to PTP was: NONEX(54.6%), EMPEX(21.8%), CBEX(15.4%) and ACO(8.2%), with p<0.05 in variables analyzed by PTP. During follow-up, there were 355 deaths(47% of patients) with statistical significance in survival time by PTP shown in the Kaplan-Meier survival curve(log rank p<0,0001). EMPEX had the highest mortality rate. Different causes of death were analyzed by PTP: 26% of NONEX died of pneumonia; while 28% of CBEX and 50% of EMPEX died of COPD exacerbation(p<0,0001). Results of univariate and multivariate Cox proportional hazard analyses showed that male sex, dyspnea, coronary heart disease, lung cancer, Charlson index and COPD PTP(NONEX, EMPEX and CBEX) were associated with high COPD mortality, while higher BMI was associated with lower mortality Conclusion: In our 15-year study, statistical significance was identified according to different PTP in terms of survival with a higher mortality in EMPEX patients. Also, some causes of death are more prevalent by PTP