Sánchez-Martínez Mª Piedad, Bernabeu-Mora Roberto, Martínez-González Mariano, Gacto-Sánchez Mariano, Martín San Agustín Rodrigo, Medina-Mirapeix Francesc
Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain.
Department of Pneumology, Hospital General Universitario J M Morales Meseguer, 30008 Murcia, Spain.
J Clin Med. 2020 Apr 18;9(4):1155. doi: 10.3390/jcm9041155.
Poor performance in the 6-min walk test (6MWT < 350 m) is an important prognostic indicator of mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Little is known about the stability of this state over time and what factors might predict a poor 6MWT performance. To determine the stability of 6MWT performance over a 2-year period in COPD patients participating in annual medical follow-up visits, and to assess the ability of several clinical, pulmonary, and non-pulmonary factors to predict poor 6MWT performance, we prospectively included 137 patients with stable COPD (mean age, 66.9 ± 8.3 years). The 6MWT was scored at baseline and 2-year follow-up. To evaluate clinical, pulmonary, and non-pulmonary variables as potential predictors of poor 6MWT performance, we used multiple logistic regression models adjusted for age, sex, weight, height, and 6MWT performance at baseline. Poor 6MWT performance was stable over 2 years for 67.4% of patients. Predictors of poor 6MWT performance included a five-repetition sit-to-stand test score ≤2 (OR, 3.01; 95% CI, 1.22-7.42), the percentage of mobility activities with limitations (OR, 1.03; 95% CI, 1.00-1.07), and poor 6MWT performance at baseline (OR, 4.64; 95% CI, 1.88-11.43). Poor 6MWT performance status was stable for the majority of COPD patients. Lower scores on the five-repetition sit-to-stand test and a higher number of mobility activities with limitations were relevant predictors of poor 6MWT performance over 2 years. Prognostic models based on these non-pulmonary factors can provide non-inferior discriminative ability in comparison with prognostic models based on only pulmonary factors.
6分钟步行试验表现不佳（6MWT＜350米）是慢性阻塞性肺疾病（COPD）患者死亡率和急性加重风险的重要预后指标。关于这种状态随时间的稳定性以及哪些因素可能预测6MWT表现不佳，目前知之甚少。为了确定参与年度医学随访的COPD患者在2年期间6MWT表现的稳定性，并评估几种临床、肺部和非肺部因素预测6MWT表现不佳的能力，我们前瞻性纳入了137例稳定期COPD患者（平均年龄66.9±8.3岁）。在基线和2年随访时对6MWT进行评分。为了评估临床、肺部和非肺部变量作为6MWT表现不佳的潜在预测因素，我们使用了经年龄、性别、体重、身高和基线时6MWT表现校正的多重逻辑回归模型。67.4%的患者在2年期间6MWT表现不佳的情况保持稳定。6MWT表现不佳的预测因素包括五次坐立试验得分≤2（比值比[OR]，3.01；95%置信区间[CI]，1.22 - 7.42）、有活动受限的活动百分比（OR，1.03；95% CI，1.00 - 1.07）以及基线时6MWT表现不佳（OR，4.64；95% CI，1.88 - 11.43）。大多数COPD患者6MWT表现不佳的状态是稳定的。五次坐立试验得分较低以及有更多活动受限的活动是2年期间6MWT表现不佳的相关预测因素。与仅基于肺部因素的预后模型相比，基于这些非肺部因素的预后模型可以提供非劣效的判别能力。
