Menezes Ana Maria B, Pérez-Padilla Rogelio, Wehrmeister Fernando César, Lopez-Varela Maria Victorina, Muiño Adriana, Valdivia Gonzalo, Lisboa Carmen, Jardim José Roberto B, de Oca Maria Montes, Talamo Carlos, Bielemann Renata, Gazzotti Mariana, Laurenti Ruy, Celli Bartolomé, Victora Cesar G
Federal University of Pelotas, Post-graduate Program in Epidemiology, Pelotas, Brazil.
National Institute of Respiratory Diseases, Sleep Clinic and Pulmonary Physiology, Mexico City, Mexico.
PLoS One. 2014 Oct 6;9(10):e109732. doi: 10.1371/journal.pone.0109732. eCollection 2014.
To determine whether the presence of chronic obstructive lung disease (COPD) and reduction of lung function parameters were predictors of mortality in a cohort.
MATERIALS/PATIENTS AND METHODS: Population based cohorts were followed in Montevideo, Santiago and Sao Paulo during 5, 6 and 9 years, respectively. Outcomes included all-cause, cardiovascular, respiratory and cancer mortality; exposures were COPD, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cox regression was used for analyses. Sensitivity, specificity, positive and negative predictive values, receiver operator characteristics curves and Youden's index were calculated.
Main causes of death were cardiovascular, respiratory and cancer. Baseline COPD was associated with overall mortality (HR = 1.43 for FEV1/FVC<LLN; 2.01 for GOLD 2-4; 1.46 for GOLD 1-4; 1.50 for FEV1/FEV6 <LLN). For cardiovascular mortality, significant associations were found with GOLD 2-4 (HR = 2.68) and with GOLD 1-4 (HR = 1.78) for both genders together (not among women). Low FEV1 was risk for overall and respiratory mortality (both genders combined). FVC was not associated with overall mortality. For most COPD criteria sensitivity was low and specificity high. The area under the curve for FEV1 was greater than for FVC for overall and cardiovascular mortality.
COPD and low FEV1 are important predictors for overall and cardiovascular mortality in Latin America.
确定慢性阻塞性肺疾病（COPD）的存在以及肺功能参数的降低是否为队列研究中死亡率的预测因素。
材料/患者与方法：分别在蒙得维的亚、圣地亚哥和圣保罗对基于人群的队列进行了5年、6年和9年的随访。结局包括全因、心血管、呼吸和癌症死亡率；暴露因素为COPD、一秒用力呼气容积（FEV1）和用力肺活量（FVC）。采用Cox回归进行分析。计算了敏感性、特异性、阳性和阴性预测值、受试者工作特征曲线及约登指数。
主要死亡原因是心血管、呼吸和癌症。基线COPD与总体死亡率相关（FEV1/FVC<下限值时HR = 1.43；GOLD 2 - 4级时为2.01；GOLD 1 - 4级时为1.46；FEV1/FEV6<下限值时为1.50）。对于心血管死亡率，在两性中（女性中未发现），GOLD 2 - 4级（HR = 2.68）和GOLD 1 - 4级（HR = 1.78）均存在显著相关性。低FEV1是总体和呼吸死亡率（两性合并）的危险因素。FVC与总体死亡率无关。对于大多数COPD标准，敏感性低而特异性高。对于总体和心血管死亡率，FEV1的曲线下面积大于FVC。
COPD和低FEV1是拉丁美洲总体和心血管死亡率的重要预测因素。
