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dc.contributor.authorArostegui Madariaga, Inmaculada
dc.contributor.authorEsteban, Cristóbal
dc.contributor.authorGarcía-Gutierrez, Susana
dc.contributor.authorBaré Mañas, Marisa
dc.contributor.authorFernández de Larrea, Nerea
dc.contributor.authorBriones, Eduardo
dc.contributor.authorQuintana López, José María
dc.date.accessioned2016-01-04T13:33:27Z
dc.date.available2016-01-04T13:33:27Z
dc.date.issued2014-06-03
dc.identifier.citationPLOS ONE 9(6) : (2014) // Article ID e98580es
dc.identifier.issn1932-6203
dc.identifier.urihttp://hdl.handle.net/10810/16583
dc.description.abstractChronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.es
dc.description.sponsorshipThis research was supported by Ministerio de Economia y Competitividad del Gobierno Espanol (MTM2010-14913), Universidad del Pais Vasco UPV/EHU (GIU10/21, UFI11/52), Departamento de Educacion, Politica Linguistica y Cultura del Gobierno Vasco (IT620-13), Departamento de Sanidad del Gobierno Vasco (2012111008) and Fondo de Investigacion Sanitaria (PI06\1010, PI06\1017, PI06\714, PI06\0326, PI06\00664). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.es
dc.language.isoenges
dc.publisherPublic Library Sciencees
dc.relationinfo:eu-repo/grantAgreement/MICINN/MTM2010-14913
dc.rightsinfo:eu-repo/semantics/openAccesses
dc.subjectobstructive pulmonary-diseasees
dc.subjectcluster-analysises
dc.subjectphenotypeses
dc.subjectbiomarkerses
dc.titleSubtypes of Patients Experiencing Exacerbations of COPD and Associations with Outcomeses
dc.typeinfo:eu-repo/semantics/articlees
dc.rights.holder2014 Arostegui et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.es
dc.relation.publisherversionhttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0098580#abstract0es
dc.identifier.doi10.1371/journal.pone.0098580
dc.departamentoesMatemática Aplicada, Estadística e Investigación Operativaes_ES
dc.departamentoeuMatematika aplikatua eta estatistikaes_ES
dc.subject.categoriaAGRICULTURAL AND BIOLOGICAL SCIENCES
dc.subject.categoriaMEDICINE
dc.subject.categoriaBIOCHEMISTRY AND MOLECULAR BIOLOGY


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