Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

• Published in: American journal of respiratory and critical care medicine Vol. 173; no. 12; pp. 1326 - 1334
• Main Authors: Martinez, Fernando J, Foster, Gregory, Curtis, Jeffrey L, Criner, Gerard, Weinmann, Gail, Fishman, Alfred, DeCamp, Malcolm M, Benditt, Joshua, Sciurba, Frank, Make, Barry, Mohsenifar, Zab, Diaz, Philip, Hoffman, Eric, Wise, Robert, NETT Research Group
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 15.06.2006; American Lung Association; American Thoracic Society
• Subjects: A. Chronic Obstructive Pulmonary Disease; Adult; Age Factors; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Mass Index; Chronic obstructive pulmonary disease; Clinical death. Palliative care. Organ gift and preservation; Cohort Studies; Dyspnea; Dyspnea - physiopathology; Emphysema; Exercise Tolerance - physiology; Female; Forced Expiratory Volume - physiology; Forecasting; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Intensive care medicine; Lungs; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Other diseases. Semiology; Oxygen Inhalation Therapy; Patients; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Emphysema - mortality; Pulmonary Emphysema - physiopathology; Quality of Life; Questionnaires; Regression analysis; Residual Volume - physiology; Risk Factors; Smoking - physiopathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Tomography; Total Lung Capacity - physiology; Ventilation-Perfusion Ratio - physiology; Human; computed tomography; Lung disease; Intensive care; Prognosis; Respiratory disease; Chronic disease; Mortality; pulmonary function; Obstruction; Bronchus disease; Computerized axial tomography; Obstructive pulmonary disease; Emphysema; Resuscitation; chronic obstructive pulmonary disease
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200510-1677OC

Limited data exist describing risk factors for mortality in patients having predominantly emphysema. A total of 609 patients with severe emphysema (ages 40-83 yr; 64.2% male) randomized to the medical therapy arm of the National Emphysema Treatment Trial formed the study group. Cox proportional hazards regression analysis was used to investigate risk factors for all-cause mortality. Risk factors examined included demographics, body mass index, physiologic data, quality of life, dyspnea, oxygen utilization, hemoglobin, smoking history, quantitative emphysema markers on computed tomography, and a modification of a recently described multifunctional index (modified BODE). Overall, high mortality was seen in this cohort (12.7 deaths per 100 person-years; 292 total deaths). In multivariate analyses, increasing age (p=0.001), oxygen utilization (p=0.04), lower total lung capacity % predicted (p=0.05), higher residual volume % predicted (p=0.04), lower maximal cardiopulmonary exercise testing workload (p=0.002), greater proportion of emphysema in the lower lung zone versus the upper lung zone (p=0.005), and lower upper-to-lower-lung perfusion ratio (p=0.007), and modified BODE (p=0.02) were predictive of mortality. FEV1 was a significant predictor of mortality in univariate analysis (p=0.005), but not in multivariate analysis (p=0.21). Although patients with advanced emphysema experience significant mortality, subgroups based on age, oxygen utilization, physiologic measures, exercise capacity, and emphysema distribution identify those at increased risk of death.