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Vol. 43. Issue 8.
Pages 445-449 (January 2007)
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Vol. 43. Issue 8.
Pages 445-449 (January 2007)
Original Article
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Risk Factors for Mortality in Chronic Obstructive Pulmonary Disease
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Ingrid Solanesa,
Corresponding author
isolanes@santpau.es

Correspondence: Dra. I. Solanes. Departamento de Neumología. Hospital de la Santa Creu i de Sant Pau. Sant Antoni Maria Claret, 167. Neumología. Módulo 4, 4.ª planta. Edificio Nuevo Hospital. 08025 Barcelona. España
, Pere Casana, Mercè Sangenísa, Núria Calafa, Beatriz Giraldob, Rosa Güella
a Departamento de Neumología, Hospital de la Santa Creu i de Sant Pau, Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
b Universidad Politécnica de Catalunya, Barcelona, Spain
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Objective

Although the factors predictive of survival in patients with chronic obstructive pulmonary disease (COPD) have been widely studied, full consensus has yet to be reached. The objective of this study was to further clarify how lung function parameters, exercise tolerance, and quality of life influence survival in patients with COPD.

Patients and Methods

This prospective study included 60 patients diagnosed with COPD. At the start of the study, patients underwent respiratory function tests, exercise testing, and 6-minute walk test. They also answered a chronic respiratory disease questionnaire to measure health-related quality of life. Follow-up lasted 7 years.

Results

Five of the 60 patients withdrew from the study. Twenty-six of the remaining 55 patients (47%) died during the study. Univariate Cox regression analysis showed a correlation between survival and age, degree of obstruction, inspiratory capacity, carbon monoxide diffusing capacity, and peak exercise tolerance. No correlation was found between survival and body mass index, PaO2, PaCO2, total lung capacity, residual volume, maximal respiratory pressures, 6-minute walk distance, or health-related quality of life.

Age, degree of obstruction (measured as the ratio of forced expiratory volume in 1 second to forced vital capacity after administration of bronchodilator), and maximum minute ventilation in the exercise test were introduced initially in the multivariate Cox stepwise regression analysis, but only maximum minute ventilation remained in the final model (relative risk, 0.926; P <.001).

Conclusions

Our findings show that peak exercise tolerance is the best predictor of survival in patients with COPD.

Key words:
COPD
Exercise tolerance
Mortality
Survival
Objetivo

Aunque los factores que predicen la supervivencia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) han sido ampliamente estudiados, no disponemos de un consenso establecido. El objetivo de este estudio ha sido contribuir a clarificar el papel que desempeñan los parámetros de función pulmonar, tolerancia al esfuerzo y calidad de vida en la supervivencia en la EPOC.

Pacientes Y MÉtodos

Se diseñó un estudio prospectivo en el que se incluyó a 60 pacientes diagnosticados de EPOC. Al inicio del estudio realizaron pruebas funcionales respiratorias, prueba de esfuerzo máximo y prueba de la marcha de 6 min, y respondieron un cuestionario de enfermedad respiratoria crónica para determinar la calidad de vida relacionada con la salud. El seguimiento de los pacientes fue de 7 años.

Resultados

Se retiraron del estudio 5 de los 60 pacientes. De los 55 restantes, 26 (47%) murieron durante el estudio. El análisis univariante con regresión de Cox mostró que existía relación entre la supervivencia y la edad, el grado de obstrucción, la capacidad inspiratoria, la capacidad de difusión del monóxido de carbono y la tolerancia al ejercicio máximo; no se observó dicha relación entre la supervivencia y el índice de masa corporal, la presión arterial de oxígeno y anhídrido carbónico, la capacidad pulmonar total, el volumen residual, las presiones máximas respiratorias, la prueba de la marcha de 6 min ni la calidad de vida relacionada con la salud.

En el análisis multivariante con regresión de Cox con pasos hacia adelante, en el que se introdujeron la edad, el grado de obstrucción (medido con la relación volumen espiratorio forzado en el primer segundo/capacidad vital forzada tras la administración de broncodilatador) y la ventilación minuto máxima en la prueba de esfuerzo, sólo esta última entró en el modelo final (riesgo relativo = 0,926; p < 0,001).

Conclusiones

Nuestros hallazgos demuestran que la tolerancia al ejercicio máximo es el mejor predictor de supervivencia en los pacientes con EPOC.

Palabras clave:
EPOC
Tolerancia al ejercicio
Mortalidad
Supervivencia
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Study supported in part by the Red-Respira-Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), Instituto de Salud Carlos III, Madrid, Spain.

Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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