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Original Article
Uncorrected Proof. Available online 22 January 2022
Cluster Analysis of Home Mechanical Ventilation in COPD Patients: A Picture of the Real World and Its Impact on Mortality
Análisis de conglomerados de ventilación mecánica domiciliaria en pacientes con EPOC: Una imagen del mundo real y su impacto en la mortalidad
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Jessica Gonzáleza,b,
Corresponding author
jgonzalezgutierrez88@gmail.com

Corresponding author.
, Paola Carmonaa,b, Esther Gracia-Lavedana,b, Iván D. Beníteza,b, Antonio Antónc, Anna Balañad, Sonia Belda Díaze, Òscar Bernadichf, Ana Córdobag, Cristina Embidh, Mireia Espallarguesi, Manel Lujánj, Sergi Martíb,k, Ortega Castilloa, M. Del Pilarl, Julia Tárregam, Ferrán Barbéa,b, Joan Escarrabilln,o, on behalf of the CatCoVer group
a Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
c Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
d Hospital del Mar, Barcelona, Spain
e Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
f Centre Hospitalari Althaia de Manresa, Barcelona, Spain
g Hospital Universitari de Bellvitge, Barcelona, Spain
h Hospital Clínic, Barcelona, Spain
i Catalan Agency for Health Quality and Evaluation AQuAS, Spain
j Hospital Parc Taulí, Barcelona, Spain
k Hospital Universitari Vall d’Hebron, Barcelona, Spain
l Hospital de Mataró, Barcelona, Spain
m Hospital de Granollers, Barcelona, Spain
n Patient Experience & Chronic Care Program, Hospital Clínic, Barcelona, Spain
o Master Plan for Respiratory Diseases, Ministry of Health, Catalonia, Spain
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Tables (2)
Table 1. Characteristics of COPD patients using Home Mechanical Ventilation in Catalonia (N=247).
Table 2. Characteristics of the patients according to the four clusters.
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Abstract
Background

Treatment of chronic hypercapnic failure in COPD patients with home noninvasive ventilation (HNIV) remains unclear.

Aim

To create a curated cohort of all COPD patients on HNIV in Catalonia, perform a cluster analysis, and evaluate mortality evolution.

Study design and methods

This study was a multicenter, observational study including all COPD patients on HNIV on 1st January of 2018. Patients were selected through the Catalan Health Service, and administrative and clinical data were obtained in the previous four years. Principal component analysis of mixed data and hierarchical clustering were performed to identify clusters of patients. Mortality was evaluated from 1 January 2018 until 31 December 2020.

Results

A total of 247 patients were enrolled. They were mostly male (78.1%), with a median (SD) age of 70.4 (9.4) years old. In 60%, 55% and 29% of patients, obesity, sleep apnea and heart failure coexisted, respectively. Cluster analysis identified four well-differentiated groups labeled for their clinical characteristics: (1) obese smokers, (2) very severe COPD, (3) sleep apnea and (4) older comorbid males. Patients belonging to Clusters (2) and (4) had a worse prognosis than patients in Clusters (1) and (3).

Interpretation

A high heterogeneity in the prescription of HNIV was demonstrated. Cluster analysis identifies four different groups, of which only one had COPD as the main cause of ventilation, while the other three clusters showed a predominance of other comorbidities. This leads to different survival outcomes, including an overlapping phenotype of obesity-related disease and sleep apnea with better survival.

Keywords:
COPD
HNIV
NIPPV
Sleep apnea
Obesity
Comorbidities
LTOT
GOLD
Abbreviations:
COPD
HNIV
NIPPV
LTOT
GOLD
Resumen
Antecedentes

El tratamiento de la insuficiencia respiratoria hipercápnica crónica en pacientes con EPOC con ventilación no invasiva domiciliaria (VNID) es controvertido.

Objetivo

Crear una cohorte de todos los pacientes con EPOC bajo VNID en Cataluña, realizar un análisis de conglomerados y evaluar con ello la mortalidad.

Material y métodos

Estudio observacional/multicéntrico que incluyó a todos los pacientes con EPOC bajo VNID al 1 de enero de 2018. Los pacientes fueron seleccionados a través del Servicio Catalán de la Salud y se obtuvieron datos administrativos de los cuatro años anteriores. Se realizó análisis de componentes principales de datos mixtos y agrupamiento jerárquico para identificar grupos de pacientes. La mortalidad se evaluó desde el 1 de enero de 2018 hasta el 31 de diciembre de 2020.

Resultados

Se reclutó un total de 247 pacientes. Mayoritariamente eran hombres (78,1%), con una edad media (DE) de 70,4 (9,4) años. En el 60, 55 y 29% de los pacientes coexistieron obesidad, apnea del sueño e insuficiencia cardíaca, respectivamente. El análisis de conglomerados identificó cuatro grupos bien diferenciados: (1) fumadores obesos, (2) EPOC muy graves, (3) apnea del sueño y (4) varones mayores comórbidos. Los pacientes pertenecientes a los grupos (2) y (4) tuvieron peor pronóstico.

Conclusiones

Se ha observado una alta heterogeneidad en la prescripción de la VNID. El análisis identificó cuatro grupos diferentes, de los cuales solo en uno, la EPOC actuaba como principal causa de ventilación. Esto condujo a diferentes patrones de supervivencia, incluido un fenotipo superpuesto de obesidad/apnea del sueño con mejor pronóstico.

Palabras clave:
EPOC
VNID
Apnea del sueño
Obesidad
Comorbilidades
OCD
GOLD
VEF1

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