Predictors of Survival in Patients with Chronic Obstructive Pulmonary Disease Treated with Long-term Oxygen Therapy

Skwarski, K; MacNee, William; Wraith, P. K.; Śliwiński, Paweł; Zieliński, J

doi:10.1378/chest.100.6.1522

Cited by 58 publications

(30 citation statements)

References 15 publications

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“…In previous studies, the results relative to this point are not concordant. FEV1, Pa,O 2 and Pa,CO 2 have shown associations in some studies [7,9,12] but not others [10,11]. Once again, these differences may partly be due to dissimilar characteristics of the patients studied.…”

Section: Discussionmentioning

confidence: 86%

“…forced expiratory volume in one second (FEV1)), arterial blood gases (e.g. arterial oxygen tension (Pa,O 2 ) and carbon dioxide arterial tension (Pa,CO 2 )), pulmonary hypertension, sex, age and body mass index (BMI), among others, are reported factors associated with mortality in these patients [6][7][8][9][10][11][12][13]. However, none of these variables have achieved a clear predictive value in all of the studies in which they were examined.…”

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confidence: 99%

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Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy

Martí

Muñoz

Rios

et al. 2006

European Respiratory Journal

126

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The aim of this study was to investigate the association between clinical variables and all-cause and respiratory mortality in patients with chronic obstructive pulmonary disease (COPD) undergoing long-term oxygen therapy (LTOT).The authors retrospectively studied a historic cohort of 128 patients with COPD (126 males, mean age¡SD 68.9¡9.7 yrs, body mass index (BMI) 25.1¡4.5 kg?m -2, and forced expiratory volume in one second 25.4¡8.8% predicted), who were being treated with long-term oxygen therapy in a tertiary teaching hospital between 1992 and 1999. Comorbidity, assessed with the Charlson Index, was present in 38% of the patients. Vital status and cause of death were assessed through the population death registry.A total of 78 patients (61%) had died by the end of follow-up. Three-year survival was 55%. Death was due to respiratory causes in 77% of cases. On Cox analysis, BMI ,25 kg?m -2 , comorbid conditions, age o70 yrs and cor pulmonale were associated with all-cause mortality. The BMI and comorbidity were the only significant predictive factors when the analysis was restricted to respiratory mortality.In conclusion, body mass index ,25 kg?m -2 and comorbidity were predictors of all-cause and respiratory mortality in a cohort of chronic obstructive pulmonary disease patients treated with long-term oxygen therapy. These factors should be taken into account when considering the management and prognosis of these patients.

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Section: Discussionmentioning

confidence: 86%

mentioning

confidence: 99%

Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy

Martí

Muñoz

Rios

et al. 2006

European Respiratory Journal

126

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“…It has been suspected, but not clearly demonstrated, that the increased life expectancy was due to the improvement of pulmonary haemodynamics. Interestingly, P pa remains an excellent prognostic factor in patients undergoing LTOT [3,27,28]. In the most recent study [3], patients with P pa .25 mmHg had a significantly lower survival rate at 5 yrs compared with patients without PH (33 versus 66%; p,0.001; fig.…”

Section: Prognostic Impact Of Ph In Patients With Copdmentioning

confidence: 88%

“…candidates for lung volume reduction surgery (LVRS) and candidates for lung transplantation, had comparable results. Mild (P pa [26][27][28][29][30][31][32][33][34][35], moderate (36)(37)(38)(39)(40)(41)(42)(43)(44)(45) and severe (.45 mmHg) PH was present in 36.7, 9.8 and 3.7% of the 215 patients, respectively. In a large series of 998 patients with COPD [6] with less airway limitation and hypoxaemia than the two studies quoted above, the P pa was 20.3¡8.1 mmHg.…”

Section: Epidemiology Of Ph In Copd Prevalence Of Ph In Copdmentioning

confidence: 99%

Pulmonary hypertension in COPD

Chaouat¹,

Naeije²,

Weitzenblum³

2008

European Respiratory Journal

532

418

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Mild-to-moderate pulmonary hypertension is a common complication of chronic obstructive pulmonary disease (COPD); such a complication is associated with increased risks of exacerbation and decreased survival. Pulmonary hypertension usually worsens during exercise, sleep and exacerbation. Pulmonary vascular remodelling in COPD is the main cause of increase in pulmonary artery pressure and is thought to result from the combined effects of hypoxia, inflammation and loss of capillaries in severe emphysema.A small proportion of COPD patients may present with ''out-of-proportion'' pulmonary hypertension, defined by a mean pulmonary artery pressure .35-40 mmHg (normal is no more than 20 mmHg) and a relatively preserved lung function (with low to normal arterial carbon dioxide tension) that cannot explain prominent dyspnoea and fatigue. The prevalence of out-ofproportion pulmonary hypertension in COPD is estimated to be very close to the prevalence of idiopathic pulmonary arterial hypertension.Cor pulmonale, defined as right ventricular hypertrophy and dilatation secondary to pulmonary hypertension caused by respiratory disorders, is common. More studies are needed to define the contribution of cor pulmonale to decreased exercise capacity in COPD. These studies should include improved imaging techniques and biomarkers, such as the B-type natriuretic peptide and exercise testing protocols with gas exchange measurements.The effects of drugs used in pulmonary arterial hypertension should be tested in chronic obstructive pulmonary disease patients with severe pulmonary hypertension. In the meantime, the treatment of cor pulmonale in chronic obstructive pulmonary disease continues to rest on supplemental oxygen and a variety of measures aimed at the relief of airway obstruction.

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“…The determinants of life expectancy in chronic obstructive pulmonary disease (COPD) have been analysed in several studies both before and after the systematic introduction of oxygen-therapy in clinical practice [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Age and degree of airway obstruction, as reflected by forced expiratory volume in one second (FEV1), are the most commonly recognized prognostic factors [12].…”

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confidence: 99%

Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease

Incalzi¹,

Fuso²,

Rosa³

et al. 1997

Eur Respir J

333

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The aim of this study was to assess the prognostic role of co-morbidity in severe chronic obstructive pulmonary disease (COPD). A cohort of 270 COPD patients, mean (+/-SD) age 67+/-9 yrs, consecutively discharged from a University Hospital after an acute exacerbation was studied. Mean (+/-SD) forced expiratory volume in one second (FEV1) was 34+/-16% of predicted and FEV1/forced vital capacity (FVC) was 40.5+/-13.8%. The most common co-morbid diseases were: hypertension (28%), diabetes mellitus (14%), and ischaemic heart disease (10%). Clinical, electrocardiogram (ECG), and respiratory function data taken at the time of discharge were collected from the clinical records. The Charlson's index was used to quantify co-morbidity. Follow-up was conducted by means of telephone calls. Multivariate survival analysis was used to identify the independent predictors of death. The median survival of the cohort was 3.1 yrs. Death was predicted by the following variables: age (hazard rate (HR) 1.04; 95% confidence intervals (95% CI) 1.02-1.05), ECG signs of right ventricular hypertrophy (HR 1.76; 95% CI 1.30-2.38), chronic renal failure (HR 1.79; 95% CI 1.05-3.02), ECG signs of myocardial infarction or ischaemia (HR 1.42; 95% CI 1.02-1.96), FEV1 < 590 mL (HR 1.49; 95% CI 0.97-2.27). A score based upon these variables predicted mortality at 5 yrs with a sensitivity of 63% and a specificity of 77%. Selected co-morbid diseases and electrocardiogram signs of right ventricular hypertrophy play a major prognostic role in advanced chronic obstructive pulmonary disease. The clinical assessment of patients with chronic obstructive pulmonary disease should include these important and easily measurable variables.

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Predictors of Survival in Patients with Chronic Obstructive Pulmonary Disease Treated with Long-term Oxygen Therapy

Cited by 58 publications

References 15 publications

Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy

Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy

Pulmonary hypertension in COPD

Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease

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