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An Integrated Index Combined by Dynamic Hyperinflation and Exercise Capacity in the Prediction of Morbidity and Mortality in COPD.
MedLine Citation:
PMID:  22348294     Owner:  NLM     Status:  Publisher    
BACKGROUND: Dynamic hyperinflation (DH) and exercise limitation develop in patients with chronic obstructive pulmonary disease (COPD); however, there is lack of knowledge about long term clinical consequences of these. We aimed to assess the impact of DH and exercise capacity in predicting mortality and also morbidity as evaluated by emergency visits and hospital admissions in COPD patients during a 4-year period. METHODS: We recruited 73 stable COPD patients. The relationships of different respiratory parameters [forced expiratory volume in the first second (FEV₁)%, body mass index, six minute walking test (6MWT) distance, static hyperinflation as measured by the inspiratory capacity-to-total lung capacity ratio (IC/TLC) in rest, DH as measured by the change between post- and pre-exercise value of IC/TLC (ΔIC/TLC), partial pressures for oxygen and carbon dioxide] with emergency visits and hospital admissions because of exacerbations and also with respiratory and all-cause mortality were assessed. RESULTS: The median follow-up period was 47 months (IQR, 45 to 48; n=73). During the follow-up there were 8 (11%) deaths. ΔIC/TLC value was 3.9±4.6%. The Kaplan-Meier survival curve showed that the cumulative survival rate was significantly lower in the patients with ΔIC/TLC>4 and with 6MWT distance≤439.56 meter, using these value as threshold (The rates for sensitivity are 100% and 87.5%, and for specificity are 56.92% and 87.69%, respectively). Cox proportional hazards model showed that DH (HR=1.4; 95CI%=1.09-1.84, p=0.009) and 6MWT distance (HR=0.98; 95CI%=0.97-0.99, p=0.006) were independent predictors of all-cause and respiratory mortality. 6MWT distance, FEV₁%, IC/TLC and ΔIC/TLC were found to be significantly related to emergency visits (r=-0.28, r=-0.41, r=- 0.24, and r=0.38, respectively) and hospital admissions (r=-0.41, r=-0.45, r=-0.36, and r=0.28, respectively). CONCLUSION: DH and exercise capacity are reliable and an independent predictors for mortality and also morbidity in COPD patients. We propose that DH and exercise capacity can be considered in the assessment of long term clinical consequences of COPD patients.
Eylem Sercan Ozgür; Sibel Atis Nayci; Cengiz Ozge; Bahar Tasdelen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-17
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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