Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD
| Autor: | Ana Ezponda, Juan P. de-Torres, Jose M. Marin, Ciro Casanova, Carlos Javier Gutiérrez Cabrera, Antonia Fuster, Cristina Martínez, Ingrid Solanes, Jessica Gonzalez-Gutierrez, Borja G. Cosío, Denis E. O'Donnell, Bartolome R. Celli, J. Alberto Neder, Marta Marín |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine BODE index Canada medicine.medical_specialty Walk Test Critical Care and Intensive Care Medicine Risk Assessment clinical DLCO Body Mass Index Pulmonary Disease Chronic Obstructive 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine Diffusing capacity COPD Humans Medicine Lung volumes 030212 general & internal medicine Mortality Carbon Monoxide Exercise Tolerance business.industry Proportional hazards model Smoking Hazard ratio Patient Acuity respiratory system Middle Aged Prognosis medicine.disease mortality Obstructive lung disease respiratory tract diseases 030228 respiratory system Spain Spirometry Cardiology Pulmonary Diffusing Capacity Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | CHEST r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname |
| ISSN: | 0012-3692 |
| Popis: | BACKGROUND: The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (DLCO) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low DLCO has not been explored. RESEARCH QUESTION: Could a DLCO threshold help define an increased risk of death and a different clinical presentation in these patients? STUDY DESIGN AND METHODS: GOLD stage I COPD patients (n = 360) were enrolled and followed over 109 +/- 50 months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for DLCO was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality. RESULTS: A DLCO cutoff value of = 60%: 9% vs DLCO < 60%: 23%, P = .01). At a same FEV1% predicted and Charlson score, patients with DLCO < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a DLCO < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) INTERPRETATION: In GOLD I COPD patients, a DLCO < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined. |
| Databáze: | OpenAIRE |
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