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Prognostic significance of distance, work, oxygen saturation and dyspnea during 6-minute walk test in COPD patients.
MedLine Citation:
PMID:  23322886     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background:Distance walked during the six-minute walk test (6MWT) predicts mortality in chronic obstructive pulmonary disease (COPD). The body weight of the patient affects the work required to walk. Calculated work during the 6MWT (6MWORK) may account for differences in walking distance resulting from change in body weight. Thus, 6MWORK might be a better predictor of mortality than distance walked. This study was designed to test this hypothesis and to assess if other variables measured during the 6MWT, like continuous oximetry recording, offered additional prognostic information.Methods:retrospective analysis of prospectively collected data, 104 COPD patients were studied. 6MWT was performed in all cases. 6MWORK was calculated as body weight (in kgs.) X distance walked (in meters). Receiver-operating characteristics curves were used to assess the value of variables to predict mortality. Additional analysis was performed using Kaplan-Meier survival plots and Cox proportional hazards regression models.Results:Mean follow-up: 590 ± 472 days.Eleven patients (10.6%) died. 6MWORK was not better than distance walked to predict mortality (AUC: 0.77 for 6MWORK vs 0.80 for distance; difference: 0.030, 95% CI: -0.054 to 0.121, p = 0.448) . Patients who died had more dyspnea (measured using Borg scale) after the 6MWT (8.5 vs 4.0, p < 0.001), lower basal SaO(2) (85% vs 93%, p = 0.001), worse oxygen saturation during the 6MWT (mean SaO2 while walking 74.0% vs 86.6%, p = 0.015) and walked less distance (255 vs 480 m, p = 0.0013). On multivariate analysis, only 6MWT distance and dyspnea after the test correlated independently with mortality (p = 0.005 for both variables).Conclusion:6MWORK was not more useful than 6MWT distance to predict mortality. The study confirms that 6MWT distance and dyspnea on exertion are key elements in prognostic evaluation in COPD, while the value of exercise oxygen desaturation is less clear.
Authors:
Rafael Golpe; Luis A Pérez-de-Llano; Lidia Méndez-Marote; Alejandro Veres-Racamonde
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-15
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Respiratory Medicine Service, Hospital Universitario Lucus Augusti, Lugo (Spain).
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