Stratification of COPD patients towards personalized medicine: reproduction and formation of clusters

• Published in: Respiratory research Vol. 23; no. 1; p. 336
• Main Authors: van Zelst, Cathelijne M, Goossens, Lucas M A, Witte, Jan A, Braunstahl, Gert-Jan, Hendriks, Rudi W, Rutten-van Molken, Maureen P M H, Veen, Johannes C C M In't
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09.12.2022; BioMed Central; BMC
• Subjects: ABCD assessment tool; Activities of Daily Living; Asthma; Body mass index; Care and treatment; Chronic obstructive pulmonary disease; Cluster analysis; Clustering; COPD; Dyspnea; Genotype & phenotype; Gold; GOLD classification; Hospitals; Humans; Lung diseases; Lung diseases, Obstructive; Medical research; Mortality; Obstructive lung disease; Patient outcomes; Patients; Personalized medicine; Phenotypes; Precision Medicine; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - therapy; Quality of Life; Questionnaires; Respiratory diseases; Respiratory Function Tests; Signs and symptoms; Spirometry; Subgroups; Netherlands; ABCD assessment tool; Phenotypes; GOLD classification; Personalized medicine; COPD
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-022-02256-7

The global initiative for chronic obstructive lung disease (GOLD) 2020 emphasizes that there is only a weak correlation between FEV , symptoms and impairment of the health status of patients with chronic obstructive pulmonary disease (COPD). Various studies aimed to identify COPD phenotypes by cluster analyses, but behavioral aspects besides smoking were rarely included. The aims of the study were to investigate whether (i) clustering analyses are in line with the classification into GOLD ABCD groups; (ii) clustering according to Burgel et al. (Eur Respir J. 36(3):531-9, 2010) can be reproduced in a real-world COPD cohort; and (iii) addition of new behavioral variables alters the clustering outcome. Principal component and hierarchical cluster analyses were applied to real-world clinical data of COPD patients newly referred to secondary care (n = 155). We investigated if the obtained clusters paralleled GOLD ABCD subgroups and determined the impact of adding several variables, including quality of life (QOL), fatigue, satisfaction relationship, air trapping, steps per day and activities of daily living, on clustering. Using the appropriate corresponding variables, we identified clusters that largely reflected the GOLD ABCD groups, but we could not reproduce Burgel's clinical phenotypes. Adding six new variables resulted in the formation of four new clusters that mainly differed from each other in the following parameters: number of steps per day, activities of daily living and QOL. We could not reproduce previously identified clinical COPD phenotypes in an independent population of COPD patients. Our findings therefore indicate that COPD phenotypes based on cluster analysis may not be a suitable basis for treatment strategies for individual patients.