University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Can Respir J. 2021 Feb 22;2021:6623093. doi: 10.1155/2021/6623093. eCollection 2021.
Identification of patients who may become hypercapnic, or develop acidotic hypercapnic respiratory failure (AHRF), is important in chronic obstructive pulmonary disease (COPD) to avoid hospital admission and select patients for use of home NIV. This study aimed to identify factors associated with presence and development of hypercapnia.
1224 patients, 637 with COPD and 587 with alpha 1 antitrypsin deficiency (AATD), from 4 previously established patient cohorts, were included in cross-sectional analyses of hypercapnia (PaCO ≥ 6.5 kPa or 48.8 mmHg), focusing on phenotypic features of COPD and mortality. Longitudinal associations of rising PaCO were also assessed. A second cohort of 160 COPD patients underwent sleep studies and 1-year follow-up, analysing in a similar way, incorporating additional information from their sleep studies if appropriate.
Hypercapnia was 15 times more common in usual COPD than AATD ( < 0.01) after adjustment for baseline differences by regression. Independent predictors of hypercapnia in COPD included FEV and current use of oxygen; these variables, together with lack of emphysema, explained 11% of variance in CO. Increasing PaCO also associated with higher risk of death (=0.03). 44/160 patients exhibited sleep disordered breathing. The sleep study cohort also showed an association of low FEV with hypercapnia. Prior hospital admission for AHRF was also clinically significant, being a feature of almost double the number of hypercapnic patients in both test and sleep study COPD cohorts.
Lower FEV and prior AHRF are the main associations of hypercapnia in COPD, which carries a poor prognosis, particularly worsening over time.
在慢性阻塞性肺疾病（COPD）中识别可能发生高碳酸血症或发展为酸中毒性高碳酸血症性呼吸衰竭（AHRF）的患者很重要，这有助于避免住院并选择使用家庭无创通气（NIV）的患者。本研究旨在确定与高碳酸血症发生和发展相关的因素。
本研究纳入了来自 4 个先前建立的患者队列的 1224 名患者，其中 637 名患有 COPD，587 名患有α1-抗胰蛋白酶缺乏症（AATD）。对这些患者进行了横断面分析，评估高碳酸血症（PaCO2≥6.5kPa 或 48.8mmHg）的存在和发展情况，重点关注 COPD 的表型特征和死亡率。还评估了 PaCO2 升高的纵向相关性。第二队列包括 160 名 COPD 患者，他们接受了睡眠研究和 1 年随访，以类似的方式进行分析，如果合适的话，还会纳入他们的睡眠研究的其他信息。
在调整了回归分析中的基线差异后，COPD 患者中高碳酸血症的发生率比 AATD 患者高 15 倍（<0.01）。COPD 患者高碳酸血症的独立预测因素包括 FEV1 和当前吸氧情况；这些变量，加上没有肺气肿，解释了 CO 中 11%的变异。PaCO2 的升高也与死亡风险增加相关（=0.03）。160 名患者中有 44 名存在睡眠呼吸障碍。睡眠研究队列也显示低 FEV1 与高碳酸血症相关。既往因 AHRF 住院治疗也是一个重要的临床特征，在测试和睡眠研究 COPD 队列中，几乎有两倍的高碳酸血症患者存在这一特征。
在 COPD 中，低 FEV1 和既往 AHRF 是高碳酸血症的主要相关因素，高碳酸血症预后不良，特别是随着时间的推移会逐渐恶化。
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