COPD AND LUNG FUNCTION PARAMETERS AS PREDICTORS OF MORTALITY: THE PLATINO COHORT STUDY

Monday, 18 August 2014
Exhibit hall (Dena'ina Center)
Ana Maria B Menezes, PhD , Universidade Federal de Pelotas, Pelotas, Brazil
Rogelio Perez Padilla, MD , National Institute of Respiratory Diseases, Mexico City, Mexico
Fernando C Wehrmeister, PhD , Federal University of Pelotas, Pelotas, Brazil
Maria Victorina Lopez-Varela, MD , Universidad de la Republica, Montevideo, Uruguay
Adriana Muiño, MD , Centro Hospitalario Pereira Rossel, Montevideo, Uruguay
Gonzalo Valdivia, MD , Pontificia Universidad Catolica de Chile, Santiago, Chile
Carmen Lisboa, MD , Pontificia Universidad Católica de Chile, Santiago, Chile
José Roberto B Jardim, MD , Federal University of São Paulo, São Paulo, Brazil
Maria Montes de Oca, MD , Universidad Central de Venezuela, Caracas, Venezuela
Carlos Tálamo, MD , Universidad Central de Venezuela, Caracas, Venezuela
Renata M Bielemann, PhD , Universidade Federal de Pelotas, Pelotas, Brazil
Mariana Gazzotti, PhD , Federal University of São Paulo, São Paulo, Brazil
Ruy Laurenti, MD , University of Sao Paulo, São Paulo, Brazil
Bartolomé Celli, MD , St. Elizabeth's Medical Center, Boston, MA
Cesar G Victora, PhD , Universidade Federal de Pelotas, Pelotas, Brazil
For the PLATINO Team , For the PLATINO Team, Pelotas, Brazil
INTRODUCTION:  

It is know that low lung function and COPD can predict subsequent mortality in high income countries. The aim of this study was to describe mortality rates according to COPD and lung function in cohorts from three Latin American (LA) cities.

METHODS:  A population based adult cohort was followed up in Montevideo, Santiago and Sao Paulo during 5, 6 and 9 years, respectively. The outcomes evaluated were: all-cause, cardiovascular, respiratory and cancer mortality; exposures were COPD and lung function parameters (FEV1and FVC). Cox regression was used in confounder-adjusted analyses. We also calculated sensitivity, specificity, positive and negative predictive values, ROC curves and Youden’s index.

RESULTS:  The main causes of death were cardiovascular, respiratory and cancer. In the adjusted models including both genders, baseline COPD was associated with overall mortality (HR 1.43 for FEV1/FVC<LLN, 2.01 for GOLD 2-4, 1.46 for the fixed ratio (FEV1/FVC<0.7) and 1.50 for FEV1/FEV6  < LLN). For cardiovascular mortality, significant associations were found with GOLD 2-4 (HR 2.68) and with the fixed ratio (HR 1.78) for both sexes together but not among women. Low FEV1 was associated with an increased risk for overall and respiratory mortality in both sexes combined. FVC did not show a significant association with overall mortality. For most COPD criteria sensitivity was low and specificity high. The area under the curve for FEV1was greater than for FVC for overall and cardiovascular mortality.

CONCLUSIONS:  COPD and low FEV1 are important predictors for overall and cardiovascular mortality in LA.