Symptom burden and its associations with clinical characteristics in patients with COPD: a clustering approach

S. Houben-Wilke, Qichen Deng, D. Janssen, F. Franssen, M. Spruit
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Abstract

Symptom burden in people with COPD is often under-recognized. In this cross-sectional analysis, we aimed to study the severity of a variety of (non-)respiratory symptoms in people with COPD and non-COPD subjects and to explore the associations between clusters based on symptom severity and other clinical characteristics.Characteristics were assessed in 538 people with COPD from primary, secondary, tertiary care and 116 non-COPD subjects. Severity of 20 symptoms was measured using a Visual Analogue Scale (VAS), ranging from 0 (no symptom) to 100 mm (maximum severity). K-means cluster analysis was applied on symptoms’ severity in the patient sample only.Patients were comparable with non-COPD subjects in terms of gender (58% vs. 55% male, p=0.132) and age (64 [9]versus63 [6] years, p=0.552) and had a reduced FEV1(57 [23]%versus111 [17]% pred, p<0.001). Patients had higher VAS scores for most symptoms (p<0.05). Most severe symptoms in patients with COPD were dyspnea, fatigue, and muscle weakness while non-COPD subjects mainly experienced insomnia and micturition. Three clusters were identified in the patient sample. Health status and care dependency differed between all clusters, while functional mobility, exacerbation history and lung function differed between clusters 1 and the other two clusters (p<0.05).People with COPD report a high burden of respiratory as well as non-respiratory symptoms. Cluster analysis demonstrated a co-occurrence of different levels of symptom severity highlighting the heterogeneity of symptoms experience. Identifying clusters of patients with shared symptom experiences can help to understand the impact of the disease and define integrated, multidimensional treatment strategies.
慢性阻塞性肺病患者的症状负担及其与临床特征的关系:一种聚类方法
慢性阻塞性肺病患者的症状负担往往未得到充分认识。在这项横断面分析中,我们旨在研究慢性阻塞性肺病患者和非慢性阻塞性肺病患者的各种(非)呼吸道症状的严重程度,并探讨基于症状严重程度和其他临床特征的群组之间的关联。20种症状的严重程度采用视觉模拟量表(VAS)进行测量,范围从0(无症状)到100毫米(最严重)。患者与非慢性阻塞性肺病患者在性别(58% 对 55%,P=0.132)和年龄(64[9]岁对 63[6]岁,P=0.552)方面具有可比性,但患者的 FEV1 有所降低(57[23]% 对 111[17]%,P<0.001)。患者大多数症状的 VAS 评分较高(P<0.05)。慢性阻塞性肺病患者最严重的症状是呼吸困难、疲劳和肌无力,而非慢性阻塞性肺病患者主要表现为失眠和排尿困难。在患者样本中发现了三个群组。所有聚类之间的健康状况和护理依赖程度均有差异,而聚类 1 和其他两个聚类之间的功能活动度、病情加重史和肺功能均有差异(P<0.05)。聚类分析显示,不同症状严重程度的患者同时出现,突出了症状体验的异质性。识别具有共同症状经历的患者群有助于了解疾病的影响,并确定综合、多维的治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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