Trajectory of the arterial-alveolar oxygen gradient in COPD for a decade
Chronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO2). The long-term trajectory and prognostic significance remain unclear. This study aimed to a...
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| Published in | PloS one Vol. 20; no. 1; p. e0318377 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
29.01.2025
Public Library of Science (PLoS) |
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| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0318377 |
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| Abstract | Chronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO2). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO2 and elucidate its trajectory over ten years.
We enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF.
157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO2 along with decreases in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO2 and higher ΔA-aDO2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO2 and ΔA-aDO2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group.
An increasing trend in A-aDO2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years. |
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| AbstractList | BackgroundChronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO2). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO2 and elucidate its trajectory over ten years.MethodsWe enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF.Results157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO2 along with decreases in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO2 and higher ΔA-aDO2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO2 and ΔA-aDO2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group.ConclusionsAn increasing trend in A-aDO2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years. Chronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO2). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO2 and elucidate its trajectory over ten years. We enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF. 157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO2 along with decreases in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO2 and higher ΔA-aDO2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO2 and ΔA-aDO2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group. An increasing trend in A-aDO2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years. Background Chronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO.sub.2). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO.sub.2 and elucidate its trajectory over ten years. Methods We enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF. Results 157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO.sub.2 along with decreases in partial pressure of oxygen (PaO.sub.2) and partial pressure of carbon dioxide (PaCO.sub.2) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO.sub.2 and higher [DELTA]A-aDO.sub.2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO.sub.2 and [DELTA]A-aDO.sub.2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO.sub.2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group. Conclusions An increasing trend in A-aDO.sub.2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO.sub.2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years. Chronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO.sub.2). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO.sub.2 and elucidate its trajectory over ten years. We enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF. 157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO.sub.2 along with decreases in partial pressure of oxygen (PaO.sub.2) and partial pressure of carbon dioxide (PaCO.sub.2) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO.sub.2 and higher [DELTA]A-aDO.sub.2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO.sub.2 and [DELTA]A-aDO.sub.2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO.sub.2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group. An increasing trend in A-aDO.sub.2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO.sub.2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years. Chronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO2). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO2 and elucidate its trajectory over ten years.BACKGROUNDChronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO2). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO2 and elucidate its trajectory over ten years.We enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF.METHODSWe enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF.157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO2 along with decreases in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO2 and higher ΔA-aDO2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO2 and ΔA-aDO2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group.RESULTS157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO2 along with decreases in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO2 and higher ΔA-aDO2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO2 and ΔA-aDO2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group.An increasing trend in A-aDO2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years.CONCLUSIONSAn increasing trend in A-aDO2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years. Background Chronic respiratory failure (CRF) is a critical complication in patients with chronic obstructive pulmonary disease (COPD) and is characterized by an increase in the arterial-alveolar oxygen gradient (A-aDO 2 ). The long-term trajectory and prognostic significance remain unclear. This study aimed to assess the prognostic impact of A-aDO 2 and elucidate its trajectory over ten years. Methods We enrolled 170 outpatients with COPD from a prospective cohort study. Arterial blood gas (ABG) analyses were conducted annually for ten years while monitoring the development of CRF. Results 157 patients completed the observation period, of whom 21 developed CRF (CRF group) and 136 did not (non-CRF group). In the CRF group, there was a gradual increase in A-aDO 2 along with decreases in partial pressure of oxygen (PaO 2 ) and partial pressure of carbon dioxide (PaCO 2 ) over ten years, although there were no changes in the non-CRF group. The CRF group had higher baseline A-aDO 2 and higher ΔA-aDO 2 in the first year than the non-CRF group (3.76 vs. 0.42 Torr/year, p = 0.030). Kaplan-Meier analyses, and multivariate Cox proportional hazards analysis revealed that both baseline A-aDO 2 and ΔA-aDO 2 were significantly associated with the development of CRF. Retrospective tracking from the initiation of long-term oxygen therapy (LTOT) revealed significant increases in A-aDO 2 from 5 years prior to LTOT initiation in the CRF group when compared to the non-CRF group. Conclusions An increasing trend in A-aDO 2 may be a significant sign for the future development of CRF. A transition of the annual change of A-aDO 2 from a stable state to a deterioration phase can serve as a prognostic factor for developing CRF within 5 years. |
| Audience | Academic |
| Author | Uemasu, Kiyoshi Hirai, Toyohiro Nagata, Kazuma Sato, Atsuyasu Tanabe, Naoya Muro, Shigeo Sato, Susumu |
| AuthorAffiliation | 3 Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara, Japan Universidad Ricardo Palma Facultad de Medicina Humana, PERU 2 Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan 1 Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan |
| AuthorAffiliation_xml | – name: 1 Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan – name: 3 Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara, Japan – name: Universidad Ricardo Palma Facultad de Medicina Humana, PERU – name: 2 Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan |
| Author_xml | – sequence: 1 givenname: Kazuma surname: Nagata fullname: Nagata, Kazuma – sequence: 2 givenname: Susumu orcidid: 0000-0002-9626-1090 surname: Sato fullname: Sato, Susumu – sequence: 3 givenname: Kiyoshi surname: Uemasu fullname: Uemasu, Kiyoshi – sequence: 4 givenname: Naoya surname: Tanabe fullname: Tanabe, Naoya – sequence: 5 givenname: Atsuyasu surname: Sato fullname: Sato, Atsuyasu – sequence: 6 givenname: Shigeo surname: Muro fullname: Muro, Shigeo – sequence: 7 givenname: Toyohiro orcidid: 0000-0002-7431-9044 surname: Hirai fullname: Hirai, Toyohiro |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39879183$$D View this record in MEDLINE/PubMed |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: S.S. reports a grant from Nippon Boehringer Ingelheim Co. and grants from Philips-Respironics, Fukuda Denshi, Fukuda Lifetec Keiji, and ResMed that did not pertain to the submitted work. K.N. reports a honoraria for lectures at Teijin Healthcare unrelated to the submitted work. S.M. reports a grant from ROHTO Pharmaceutical unrelated to submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. |
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| Title | Trajectory of the arterial-alveolar oxygen gradient in COPD for a decade |
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