Almagro, PereMartinez-Camblor, PabloSoriano, Joan B.Marin, Jose M.Alfageme, InmaculadaCasanova, CiroEsteban, CristobalSoler-Cataluña, Juan J.de-Torres, Juan P.Celli, BartolomeMiravitlles, Marc2014-04-112014Almagro, P., P. Martinez-Camblor, J. B. Soriano, J. M. Marin, I. Alfageme, C. Casanova, C. Esteban, et al. 2014. “Finding the Best Thresholds of FEV1 and Dyspnea to Predict 5-Year Survival in COPD Patients: The COCOMICS Study.” PLoS ONE 9 (2): e89866. doi:10.1371/journal.pone.0089866. http://dx.doi.org/10.1371/journal.pone.0089866.1932-6203http://nrs.harvard.edu/urn-3:HUL.InstRepos:12064538Background: FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence. Objectives: We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients. 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. 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. 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.en-USMedicineAnatomy and physiologyRespiratory systemRespiratory physiologyClinical research designCohort studiesEpidemiologyObservational studiesDiagnostic medicineTest evaluationDisease informaticsPulmonologyChronic obstructive pulmonary diseasesJournal Article2014-04-1110.1371/journal.pone.0089866