Clinical relevance of lung function trajectory clusters in middle-aged and older adults.

IF 4.3 3区医学 Q1 RESPIRATORY SYSTEM ERJ Open Research Pub Date : 2024-02-05 eCollection Date: 2024-01-01 DOI:10.1183/23120541.00793-2023

Xander Bertels, James C Ross, Rosa Faner, Michael H Cho, M Arfan Ikram, Guy G Brusselle, Lies Lahousse

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Abstract

Background: The determinants and health outcomes of lung function trajectories in adults among the general population are poorly understood. We aimed to identify and characterise clusters of lung function trajectories in adults aged ≥45 years.

Methods: Gaussian finite-mixture modelling was applied to baseline and annualised change of forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC ratio z-scores in participants of the Rotterdam Study, a prospective population-based cohort study, with repeated spirometry (n=3884; mean±sd age 64.7±8.9 years). Longitudinal outcomes were all-cause mortality, respiratory outcomes (symptoms, COPD (FEV₁/FVC <0.7 in absence of asthma), preserved ratio impaired spirometry (PRISm; FEV₁/FVC ≥0.7 and FEV₁ or FVC <80%)), smoking cessation and weight changes. Independent risk factors, including genetics, were identified by multiple logistic regression.

Results: We identified eight trajectory clusters, with the reference group having persistently normal spirometry (prevalence 42.8%). Three clusters showed higher mortality, adjusted for confounders: 1) the persistently low FEV₁ cluster (prevalence 6.8%, hazard ratio (HR) 1.71, 95% CI 1.37-2.13); 2) rapid FEV₁ decliners (prevalence 4.6%, HR 1.48, 95% CI 1.10-1.99); and 3) FVC decliners (prevalence 3.7%, HR 1.49, 95% CI 1.09-2.03). In contrast, FVC improvers (prevalence 6.7%, HR 0.61, 95% CI 0.41-0.90) and persistently high FEV₁ (prevalence 29.2%, HR 0.82, 95% CI 0.69-0.98) were protective trajectory clusters. Clusters were characterised by differences in genetic predisposition (polygenic scores of FEV₁ and FEV₁/FVC), demographics, cigarette smoking, respiratory symptoms (chronic cough, wheezing and dyspnoea), cardiovascular factors (body mass index, hypertension and heart failure) and serum C-reactive protein levels. Frailty, weight changes and the development of respiratory symptoms, COPD and PRISm were significantly associated with trajectory clusters.

Conclusions: This study reveals clinically relevant lung function trajectory clusters in older adults of the general population.

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中老年人肺功能轨迹群的临床相关性。

背景：人们对普通人群中成年人肺功能轨迹的决定因素和健康结果知之甚少。我们的目的是在年龄≥45 岁的成年人中识别肺功能轨迹集群并确定其特征：对鹿特丹研究（一项基于人群的前瞻性队列研究）参与者的 1 秒用力呼气容积 (FEV1)、用力肺活量 (FVC) 和 FEV1/FVC 比值 z score 的基线和年化变化应用了高斯有限混合物模型，并重复进行了肺活量测定（n=3884；平均年龄（±sd）为 64.7±8.9 岁）。纵向结果包括全因死亡率、呼吸系统结果（症状、慢性阻塞性肺病（FEV1/FVC 1/FVC ≥0.7、FEV1 或 FVC 结果）：我们发现了八个轨迹群，参照组的肺活量持续正常（发病率为 42.8%）。在对混杂因素进行调整后，三个群组的死亡率较高：1）持续低 FEV1 组（流行率 6.8%，危险比 (HR) 1.71，95% CI 1.37-2.13）；2）快速 FEV1 下降组（流行率 4.6%，HR 1.48，95% CI 1.10-1.99）；3）FVC 下降组（流行率 3.7%，HR 1.49，95% CI 1.09-2.03）。相比之下，FVC 改善者（发病率为 6.7%，HR 为 0.61，95% CI 为 0.41-0.90）和 FEV1 持续偏高者（发病率为 29.2%，HR 为 0.82，95% CI 为 0.69-0.98）属于保护性轨迹群。不同的遗传倾向（FEV1 和 FEV1/FVC 的多基因评分）、人口统计学特征、吸烟、呼吸道症状（慢性咳嗽、喘息和呼吸困难）、心血管因素（体重指数、高血压和心力衰竭）和血清 C 反应蛋白水平的差异是这些群组的特征。虚弱、体重变化和呼吸道症状、慢性阻塞性肺病和 PRISm 的发展与轨迹群显著相关：这项研究揭示了普通人群中老年人肺功能的临床相关轨迹集群。

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来源期刊

ERJ Open Research Medicine-Pulmonary and Respiratory Medicine

CiteScore

6.20

自引率

4.30%

发文量

273

审稿时长

8 weeks

期刊介绍： ERJ Open Research is a fully open access original research journal, published online by the European Respiratory Society. The journal aims to publish high-quality work in all fields of respiratory science and medicine, covering basic science, clinical translational science and clinical medicine. The journal was created to help fulfil the ERS objective to disseminate scientific and educational material to its members and to the medical community, but also to provide researchers with an affordable open access specialty journal in which to publish their work.