Prognostic determinants in AECOPD differ by cardiovascular disease status: a two-center retrospective cohort study in China
7 affiliations
- 1Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
- 2Department of Respiratory Medicine, Center for Pathogen Biology and Infectious Diseases, Key Laboratory of Organ Regeneration and Transplantation of The Ministry of Education, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, The First Hospital of Jilin University
- 3Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University
- 4National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention
- 5Department of Cardiology, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences
- 6Department of Nutrition and Food Hygiene, School of Public Health, Jilin University
- 7Department of Medicine, Pulmonary, and Critical Care Medicine, German Center for Lung Research (DZL), University of Marburg
Abstract
Background Cardiovascular disease (CVD) comorbidity is common among patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and is associated with poor prognosis. However, whether the presence of CVD modifies the prognostic determinants in AECOPD remains unclear, and there is a lack of validated risk stratification tools that account for this heterogeneity, particularly in China. Methods This retrospective cohort study enrolled 1584 patients hospitalized for AECOPD from two centers in China. Patients were classified as CVD or non-CVD based on prespecified cardiovascular conditions. Cause-specific mortality was analyzed using data linked to the National Mortality Surveillance System. The primary outcome was overall survival from index hospitalization (OS1). OS2 (from first symptom onset) was analyzed as an exploratory outcome. Hospitalization duration was modeled using negative binomial regression. The models were developed in the Beijing cohort (70% training/30% internal test) and externally validated in the Jilin cohort. Results Respiratory-related death was the predominant cause across all subgroups, accounting for approximately half of all deaths. Compared with non-CVD patients, those with CVD had significantly longer hospital stays (8.71 days vs 7.98 days, P < 0.001) and worse long-term survival (3-year OS1 rate: 76.6% vs. 85.4%, P < 0.001). External validation demonstrated moderate discrimination for the CVD model of OS1 (C-index: 0.700, 95% CI 0.611–0.773) and non-CVD model of OS1 (C-index: 0.662, 95%CI 0.565–0.744). Sensitivity analysis including hypertension in the CVD definition and filtering early death yielded consistent results. Conclusions Our findings suggest that prognostic determinants differ substantially between CVD and non-CVD groups, supporting a hypothesis-generating framework for stratified risk assessment. A stratified prognostication framework in which CVD status dictates the use of different risk calculators was built and paved the way for more practical management strategies in China.
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BibTeX
@article{tong2026prognostic,
title = {{Prognostic determinants in AECOPD differ by cardiovascular disease status: a two-center retrospective cohort study in China}},
author = {Xunliang Tong and Tongji Xie and Ying Tang and Lan Liu and Peng Yin and Tianyu Li and Donghao Liu and Xiaowei Jiang and Xiaoman Du and Yuan Zhang and Weiwei Cui and Claus F. Vogelmeier and Dan Li and Yanming Li},
journal = {European Journal of Medical Research},
year = {2026},
month = oct,
doi = {10.1186/s40001-026-05336-2},
url = {https://doi.org/10.1186/s40001-026-05336-2},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prognostic determinants in AECOPD differ by cardiovascular disease status: a two-center retrospective cohort study in China
AU - Xunliang Tong
AU - Tongji Xie
AU - Ying Tang
AU - Lan Liu
AU - Peng Yin
AU - Tianyu Li
AU - Donghao Liu
AU - Xiaowei Jiang
AU - Xiaoman Du
AU - Yuan Zhang
AU - Weiwei Cui
AU - Claus F. Vogelmeier
AU - Dan Li
AU - Yanming Li
PY - 2026
DA - 2026/10/25
JO - European Journal of Medical Research
DO - 10.1186/s40001-026-05336-2
UR - https://doi.org/10.1186/s40001-026-05336-2
AB - Background Cardiovascular disease (CVD) comorbidity is common among patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and is associated with poor prognosis. However, whether the presence of CVD modifies the prognostic determinants in AECOPD remains unclear, and there is a lack of validated risk stratification tools that account for this heterogeneity, particularly in China. Methods This retrospective cohort study enrolled 1584 patients hospitalized for AECOPD from two centers in China. Patients were classified as CVD or non-CVD based on prespecified cardiovascular conditions. Cause-specific mortality was analyzed using data linked to the National Mortality Surveillance System. The primary outcome was overall survival from index hospitalization (OS1). OS2 (from first symptom onset) was analyzed as an exploratory outcome. Hospitalization duration was modeled using negative binomial regression. The models were developed in the Beijing cohort (70% training/30% internal test) and externally validated in the Jilin cohort. Results Respiratory-related death was the predominant cause across all subgroups, accounting for approximately half of all deaths. Compared with non-CVD patients, those with CVD had significantly longer hospital stays (8.71 days vs 7.98 days, P < 0.001) and worse long-term survival (3-year OS1 rate: 76.6% vs. 85.4%, P < 0.001). External validation demonstrated moderate discrimination for the CVD model of OS1 (C-index: 0.700, 95% CI 0.611–0.773) and non-CVD model of OS1 (C-index: 0.662, 95%CI 0.565–0.744). Sensitivity analysis including hypertension in the CVD definition and filtering early death yielded consistent results. Conclusions Our findings suggest that prognostic determinants differ substantially between CVD and non-CVD groups, supporting a hypothesis-generating framework for stratified risk assessment. A stratified prognostication framework in which CVD status dictates the use of different risk calculators was built and paved the way for more practical management strategies in China.
SN - 2047-783X
ER -