Sex-specific associations of comorbidome and pulmorbidome with mortality in chronic obstructive pulmonary disease : results from COSYCONET

Abstract

In patients with COPD, it has not been comprehensively assessed whether the predictive value of comorbidities for mortality difers between men and women. We therefore aimed to examine sex diferences 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, signifcant predictors in men were impairment in difusion capacity and hyperinfation, in women asthma and hyperinfation. Similar results were obtained when repeating the analyses in GOLD 1–4 patients only. Gender diferences should be considered in COPD risk assessment for a tailored approach towards the treatment of COPD.