• Pei Yee Tiew, KoFanny Wai SanFWSDepartment of Medicine and Therapeutics The Chinese University of Hong Kong, Hong Kong., Jayanth Kumar Narayana, Mau Ern Poh, Huiying Xu, Han Yee Neo, Li-Cher Loh, Choo Khoon Ong, Micheál Mac Aogáin, TanJessica Han YingJHYDepartment of General Medicine, Sengkang General Hospital, Singapore., Nabilah Husna Kamaruddin, SimGerald Jiong HuiGJHDepartment of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore., Therese S Lapperre, Mariko Siyue Koh, HuiDavid Shu CheongDSCDepartment of Medicine and Therapeutics The Chinese University of Hong Kong, Hong Kong., John Arputhan Abisheganaden, Augustine Tee, Krasimira Tsaneva-Atanasova, and Sanjay H Chotirmall.
• Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
• Chest. 2020 Jul 1; 158 (1): 145156145-156.

BackgroundCOPD is a heterogeneous disease demonstrating inter-individual variation. A high COPD prevalence in Chinese populations is described, but little is known about disease clusters and prognostic outcomes in the Chinese population across Southeast Asia. We aim to determine if clusters of Chinese patients with COPD exist and their association with systemic inflammation and clinical outcomes.Research QuestionWe aim to determine if clusters of Chinese patients with COPD exist and their association with clinical outcomes and inflammation.Study Design And MethodsChinese patients with stable COPD were prospectively recruited into two cohorts (derivation and validation) from six hospitals across three Southeast Asian countries (Singapore, Malaysia, and Hong Kong; n = 1,480). Each patient was followed more than 2 years. Clinical data (including co-morbidities) were employed in unsupervised hierarchical clustering (followed by validation) to determine the existence of patient clusters and their prognostic outcome. Accompanying systemic cytokine assessments were performed in a subset (n = 336) of patients with COPD to determine if inflammatory patterns and associated networks characterized the derived clusters.ResultsFive patient clusters were identified including: (1) ex-TB, (2) diabetic, (3) low comorbidity: low-risk, (4) low comorbidity: high-risk, and (5) cardiovascular. The cardiovascular and ex-TB clusters demonstrate highest mortality (independent of Global Initiative for Chronic Obstructive Lung Disease assessment) and illustrate diverse cytokine patterns with complex inflammatory networks.InterpretationWe describe clusters of Chinese patients with COPD, two of which represent high-risk clusters. The cardiovascular and ex-TB patient clusters exhibit high mortality, significant inflammation, and complex cytokine networks. Clinical and inflammatory risk stratification of Chinese patients with COPD should be considered for targeted intervention to improve disease outcomes.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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