Finding the best thresholds of FEV1and dyspnea to predict 5-year survival in COPD patients: The COCOMICS study

Citations of this article
Mendeley users who have this article in their library.


BACKGROUND: FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence.<br /><br />OBJECTIVES: We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients.<br /><br />DESIGN AND METHODS: We conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival.<br /><br />RESULTS: A total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.4 ± 9.7, and predicted FEV1 of 53.8% (± 19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild ≥ 70%, moderate 56-69%, severe 36-55%, and very severe ≤ 35%. Survival at 5 years was 0.89 for patients with FEV1 ≥ 70 vs. 0.46 in patients with FEV1 ≤ 35% (H.R: 6; 95% C.I.: 4.69-7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear.<br /><br />CONCLUSIONS: The best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by ≥ 70%, 56-69%, 36-55%, and ≤ 35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs.




Almagro, P., Martinez-Camblor, P., Soriano, J. B., Marin, J. M., Alfageme, I., Casanova, C., … Miravitlles, M. (2014). Finding the best thresholds of FEV1and dyspnea to predict 5-year survival in COPD patients: The COCOMICS study. PLoS ONE, 9(2).

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free