The Association of Depressive Symptoms With Rates of Acute Exacerbations in Patients With COPD: Results From a 3-year Longitudinal Follow-up of the ECLIPSE Cohort

Abstract

Background: Depression increases disability and health care utilization in older patients with chronic obstructive pulmonary disease (COPD).

Objectives: To determine contribution of depressive symptoms to the incidence of moderate-severe and severe acute exacerbations of COPD (AECOPD) over 3 years.

Design: We analyzed data collected from a prospective cohort of patients with COPD (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; ECLIPSE).

Setting: Multicentered outpatient.

Participants: A total of 2059 patients with COPD with complete data (63.7% men, mean age 63.4 + 7.1 years).

Measurements: Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Moderate-severe AECOPDs were collected; a subset of very severe AECOPD was defined as requiring hospital admission.

Results: A total of 540 (26%) patients with COPD reported high depressive symptoms (CES-D ≥16). High depressive symptoms at baseline related to an increased risk of moderate-severe and severe AECOPD during the follow-up (odds ratio [OR] 1.18; 95% confidence interval [CI] 1.07-1.30; for moderate-severe and OR 1.36; 95% CI 1.09-1.69 for severe events risk of hospitalizations) independent of key covariates of an AECOPD history before recruitment in the study, history of gastroesophageal reflux, baseline severity of airflow limitation, and white blood cell count that were also associated with an increased risk of moderate to severe exacerbations (all P < .001).

Conclusion: Presence of high depressive symptoms at baseline were associated with subsequent moderate-severe exacerbations and hospital admissions in patients with COPD over 3 years, independent of a history of exacerbations and other demographic and clinical factors. Targeted personalized medicine that focuses both on AECOPD risk and depression may be a step forward to improving prognosis of patients with COPD.

Keywords: AECOPD; COPD; acute exacerbations; depression; hospitalization; longitudinal study; previous history of exacerbation.