Abstract
Background: This study describes trends in health-related quality of life (HRQL) over 18 months in a large cohort of COPD patients and identifies predictors of deterioration.
Methods: 18 months after baseline, SGRQ, CAT and the EQ-5D-3L questionnaire were re-assessed in 2040 participants of the German COPD cohort COSYCONET. Predictors for a clinically relevant HRQL deterioration (using established MCIDs) were identified by logistic regression models using baseline information on HRQL score, GOLD grade, age, sex, education, smoking, comorbidity, symptoms, BMI and exacerbation history.
Results: Mean FEV1 declined by 86ml over 18 months, whereas mean generic/COPD-specific HRQL scores of participants (59% males, mean age 65y, FEV1 58%pred) were stable. Despite this, there was a considerable share of participants with clinically relevant HRQL worsening (33% for SGRQ, 30% for CAT, 26% for EQ-5D utility). For the SGRQ, patients with baseline GOLD grade 3 or 4 had a significantly higher risk of deterioration compared to grade 1 (OR=2.4, OR=1.6, respectively). Furthermore, underweight (OR=1.9) or a history of a severe exacerbation (OR=1.6) were associated with the risk of deterioration, while higher education reduced this risk (OR=0.7). These factors were also significant predictors when using CAT and EQ-5D. For CAT and EQ-5D, having >3 comorbidities was an additional predictor of deterioration (OR=1.4/OR=1.3). Baseline dyspnea (mMRC>2) (OR=1.6) and sputum (OR=1.4) were further predictors for the EQ-5D only.
Conclusion: Knowledge about factors predicting change in HRQL helps to identify subgroups of patients with special needs for care.
- Copyright ©the authors 2017
