Respiratory parameters predict poor outcome in COPD patients, category GOLD 2017 B

Abstract

BackgroundRespiratory parameters are important predictors of prognosis in the COPD population. Global Initiative for Obstructive Lung Disease (GOLD) 2017 Update resulted in a vertical shift of patients across COPD categories, with category B being the most populous and clinically heterogeneous. The aim of our study was to investigate whether respiratory parameters might be associated with increased all-cause mortality within GOLD category B patients.MethodsThe data were extracted from the Czech Multicentre Research Database, a prospective, noninterventional multicenter study of COPD patients. Kaplan–Meier survival analyses were performed at different levels of respiratory parameters (partial pressure of oxygen in arterial blood [PaO2], partial pressure of arterial carbon dioxide [PaCO2] and greatest decrease of basal peripheral capillary oxygen saturation during 6-minute walking test [6-MWT]). Univariate analyses using the Cox proportional hazard model and multivariate analyses were used to identify risk factors for mortality in hypoxemic and hypercapnic individuals with COPD.ResultsAll-cause mortality in the cohort at 3 years of prospective follow-up reached 18.4%. Chronic hypoxemia (PaO2 <7.3 kPa), hypercapnia (PaCO2 >7.0 kPa) and oxygen desaturation during the 6-MWT were predictors of long-term mortality in COPD patients with forced expiratory volume in 1 second ≤60% for the overall cohort and for GOLD B category patients. Univariate analyses confirmed the association among decreased oxemia (<7.3 kPa), increased capnemia (>7.0 kPa), oxygen desaturation during 6-MWT and mortality in the studied groups of COPD subjects. Multivariate analysis identified PaO2 <7.3 kPa as a strong independent risk factor for mortality.ConclusionSurvival analyses showed significantly increased all-cause mortality in hypoxemic and hypercapnic GOLD B subjects. More important, PaO2 <7.3 kPa was the strongest risk factor, especially in category B patients. In contrast, the majority of the tested respiratory parameters did not show a difference in mortality in the GOLD category D cohort.

Introducing a new prognostic instrument for long-term mortality prediction in COPD patients: the CADOT index

“…COPD is considered a heterogeneous syndrome with inter-individual differences in disease manifestation, comorbidity and long-term mortality risk 4,5 . For this reason, accurate tools for estimating the life expectancy of COPD patients are warranted 6,7 . The BODE (Body mass index, airflow Obstruction, Dyspnoea and Exercise) and the ADO (Age, Dyspnoea and Obstruction) indices are globally the most widely used instruments for long-term mortality assessment 8,9 .…”

Impact of Hyponatremia on COPD Exacerbation Prognosis

“…However, whether hyponatremia has a direct effect on mortality, or whether it is a severity marker in certain patients, is unknown [3]. Prognostic factors in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) include baseline disease severity, frequency and severity of exacerbations, age, various comorbidities, history of previous admissions for AECOPD, severity of exacerbations, and a series of physiological and laboratory parameters, such as lung function, respiratory rate at admission, hypoxemia, and hypercapnia [12,13]. Although previous studies show that hyponatremia, particularly when severe, is a predictor of poor prognosis in chronic obstructive pulmonary disease (COPD) [2], few studies determine the prevalence and impact of hyponatremia on the prognosis in the patients with AECOPD requiring hospitalization.…”

Cellular Mechanisms Involved in the Pathogenesis of Airway Remodeling in Chronic Lung Disease

“…We explored the effect of hypoxia as a stimulus that would be representative of acute pulmonary diseases, in which hypoxemia would occur as a consequence of the severity of the disease. Although current COPD recommendations no longer consider respiratory failure as a component when measuring the severity of the disease 37 , patients with COPD and secondary hypoxemia should be classed as particularly serious cases from a clinical perspective, and they have serious prognostic implications 38 .…”