Predictors for development of major cardiovascular events in elderly patients with severe and extremely severe chronic obstructive pulmonary disease in combination with early stages of chronic kidney disease

Abstract

Aim. To study the structure of major cardiovascular events (MCVE) and to identify their independent predictors in elderly patients with severe and extremely severe chronic obstructive pulmonary disease (COPD) in combination with early stages of chronic kidney disease (CKD). Materials and methods. The study included 172 elderly patients with stage 3–4 COPD associated with stage 1–2 CKD. Initially, risk factors for MCVE were identified and levels of vitamin D (25 (ОН) D) were measured for all patients. In 12 months, MCVE anamnesis was collected, and patients were divided into two groups with and without MCVE during the observation period. The risk factors for MCVE, which were significantly different between the two groups according to results of a one-way analysis, were successively included into a logistic regression for identifying independent predictors of MCVE. A ROC analysis was performed for the identified variables to identify a predictive cut-off point. Results. 21 MCVEs were observed in 8.7% (15) patients. Heart rhythm disorders (HRD) not reversed at the prehospital stage were observed in 38.1% patients; acute cerebrovascular disease and transient ischemic attack – in 23.8%, acute coronary syndrome – in 23.8%, and pulmonary thromboembolism (PTE) – in 14.3%. Two MCVEs, namely, a combination of HRD not reversed at the prehospital stage and PTE, were observed in 3 (20%) patients. The ROC analysis showed that the incidence of COPD exacerbation for the previous 12 months >3 had the highest predictive value for the 12-month risk of MCVE in patients with COPD associated with early CKD (95% CI, 0.823–0.925, р=0.001). A total PROCAM score <50 (95% CI, 0.882–0.964, р=0.001); GFR ≥80 ml/min/1.73 m2 (95% CI, 0.750–0.870, р=0.001); and a level of vitamin D ≥33 ng/ml (95% CI, 0.730–0.855, р=0.001) reduced the risk for MCVE. Conclusions. In elderly patients with grade 3–4 COPD associated with stage 1–2 CKD, the development of MCVE within 12 months was determined by the incidence of COPD exacerbations for the previous 12 months >3 while a total PROCAM score <50, GFR >80 ml/min/1.73 m3 , and levels of vitamin D >33 ng/ml reduced the risk of MCVE in these patients