Predicting of the risk of major cardiovascular events developing in patients with chronic obstructive pulmonary disease in combination with renal dysfunction
https://doi.org/10.15829/1728-8800-2019-3-75-80
Abstract
Aim. To identify the independent predictors of major cardiovascular events (MCVE) in patients with chronic obstructive pulmonary disease (COPD) in combination with the early stages of chronic kidney disease (CKD).
Material and methods. The study included 279 patients with GOLD 2014 2-4 severity COPD. At the first stage, we surveyed the potential risk factors for MCVE and the level of 25-OH vitamin D. After 12 months, all patients had a history of MCVE. Patients were divided into 2 groups: those who had MCVE during the previous 12 months, and without them. The risk factors for the development of MCVE, significantly differing between the two groups according to the results of a univariate analysis, were included in the logistic regression to determine reliable independent predictors of MCVE. We also studied ROC curve to identify the prognostic cut-off point.
Results. The group of patients who had MCVE consisted of 37 people with 40 MCVE cases. In patients with COPD in combination with the early stage of CKD, the level of vitamin D, the frequency of exacerbations in the preceding 12 months, the glomerular filtration rate (GFR), the score of PROCAM scale significantly influence to the development of MCVE. For the constructed regression equation, the determination coefficient is defined as R2=0,76, Hosmer-Lemeshov criterion =0,8. The area under the curve for the model =0,95. According to the results of the ROC analysis, it was found that independent predictors of MCVE in a 12-month period in patients with COPD and CKD (early stages) are: the sum of PROCAM scale points >56, the frequency of COPD exacerbations for the previous 12 months >2, GFR <80 ml/min/1,73 m2, the level of vitamin D <34,3 ng/ml.
Conclusion. Independent predictors of MCVE in a 12-month period in patients with COPD and the early stages of CKD are: the score of the PROCAM scale >56, the frequency of exacerbations of COPD in the preceding 12 months >2, GFR <80 ml/min/1,73 m2, the level of vitamin D <34,3 ng/ml.
About the Authors
E. V. Bolotova
Kuban State Medical University
Russian Federation
Krasnodar
Russian Federation
Krasnodar
V. V. Yavlyanskaya
Kuban State Medical University;
Regional Clinical Hospital № 2
Russian Federation
Krasnodar
Russian Federation
Krasnodar
A. V. Dudnikova
Regional Clinical Hospital № 2
Russian Federation
Krasnodar
Russian Federation
Krasnodar
References
1. Report GOLD: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org January 2015.
2. Soriano JB, Abajobir AA, Abate KH, et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691-706. doi:10.1016/S2213-2600(17)30293-X.
3. Yoshizawa T, Okada K, Furuichi S, et al. Prevalence of chronic kidney diseases in patients with chronic obstructive pulmonary disease: assessment based on glomerular filtration rate estimated from creatinine and cystatin C levels. Int J Chron Obstruct Pulmon Dis. 2015;10:1283-9. doi:10.2147/COPD.S80673.
4. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. Suppl. 2013;84(3):622-3. doi:10.1038/kisup.2012.37.
5. Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest. 2010;137:1091-7. doi:10.1378/chest.09-2029.
6. Halpin DM, Decramer M, Celli B, et al. Risk of nonlower respiratory serious adverse events following COPD exacerbations in the 4-year UPLIFT Trial. Lung. 2011;189:2618. doi:10.1007/s00408-011-9301-8.
7. Portegies ML, Lahousse L, Joos GF, et al. Chronic Obstructive Pulmonary Disease and the Risk of Stroke. The Rotterdam Study. Am J Respir Crit Care Med. 2016;193(3):251-8. doi:10.1164/rccm.201505-0962OC.
8. Windsor C, Herrett E, Smeeth L, et al. No association between exacerbation frequency and stroke in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:217-25. doi:10.2147/COPD.S95775.
9. Vogelmeier C, Vestbo J. COPD assessment: I, II, III, IV and/or A, B, C, D. Eur Respir J. 2014;43(4):949-50. doi:10.1183/09031936.00019714.
10. Moiseev VS, Muhin NA, Muhin AV, et al. National recommendations. Cardiovascular risk and chronic kidney disease: strategies for cardio-nephroprotection. Clinical nephrology. 2014;2:4-29. (In Russ.)
11. Eisen A, Hoshen M, Balicer RD, et al. Estimated Glomerular Filtration Rate Within the Normal or Mildly Impaired Range and Incident Cardiovascular Disease. Am J Med. 2015 Sep;128(9):1015-22.e2. doi:10.1016/j.amjmed.2015.03.024.
12. Bolotova EV Dudnikova AV Iavlianskaia VV. Features of diagnosis of chronic kidney disease in patients with chronic obstructive pulmonary disease. Clinical nephrology. 2017;1:18-22. (In Russ.)
13. Currie G, Delles C. Proteinuria and its relation to cardiovascular disease. Int J Nephrol Renovasc Dis. 2014;7:13-24. doi:10.2147/IJNRD.S40522.
14. Fruchter O, Yigla M, Kramer MR. Lipid profile and statin use: the paradox of survival after acute exacerbation of chronic obstructive pulmonary disease.Am J Med Sci. 2015;349(4):338-43. doi:10.1097/MAJ.0000000000000435.
15. Janssens W, Bouillon R, Claes B, et al. Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the Vitamin D-binding gene. Thorax. 2010;65:215-20. doi:10.1136/thx.2009.120659.
16. Lee HM, Liu M, Lee K, et al. Does low vitamin D amplify the association of COPD with total and cardiovascular disease mortality? Clin Cardiol. 2014;37(8):473-8. doi:10.1002/clc.22284.
17. Durup D, Jorgensen HL, Christensen J, et al. Reverse J-Shaped Association Between Serum 25-Hydroxyvitamin D and Cardiovascular Disease Mortality: The CopD Study. Clin Endocrinol Metab. 2015;100(6):2339-46. doi:10.1210/jc.2014-4551.
Review
For citations:
Bolotova E.V., Yavlyanskaya V.V., Dudnikova A.V. Predicting of the risk of major cardiovascular events developing in patients with chronic obstructive pulmonary disease in combination with renal dysfunction. Cardiovascular Therapy and Prevention. 2019;18(3):75-80. (In Russ.) https://doi.org/10.15829/1728-8800-2019-3-75-80
Views:
611
Email this article 
