Department of Physiotherapy, University of Murcia, and Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.
Department of Physiotherapy, University of Murcia, Spain.
Ann Phys Rehabil Med. 2022 Sep;65(5):101598. doi: 10.1016/j.rehab.2021.101598. Epub 2021 Nov 20.
Prognostic studies suggest that some musculoskeletal and functional capacity tests are independently associated with mortality in chronic obstructive pulmonary disease (COPD), but comparing their prognostic value is difficult because of differences in the selected covariates for regression modelling in those studies.
To assess the prognostic value of five musculoskeletal and functional capacity tests in predicting mortality risk in patients with COPD after adjusting for existing and confounding prognostic factors and to compare their ability to correctly discriminate the mortality of individual participants using the 6-min walk test (6MWT). We hypothesized that the examined tests have different prognostic value.
Prospective and longitudinal study. A total of 137 patients with stable COPD (mean [SD] age 67 [8.33] years; 87% male) were recruited from a hospital in Spain during 2014 and followed for 5 years (2014-2019). No one refused and only one was lost to follow-up. The outcome measure was 5 year all-cause mortality.
A total of 37 patients died within 5 years. All musculoskeletal tests were associated with 5 year all-cause mortality in Cox proportional-hazards regression models. However, only the five-repetition sit-to-stand test (5-STS) score was an independent prognostic factor (hazard ratio 1.04 per sec, 95% confidence interval 1.01-1.08) after adjusting for history of heart disease, number of previous severe exacerbations, and dyspnoea. This model explained 50.7% of the variance in mortality. This test exhibited similar discriminative ability as the 6MWT for 5 year mortality (area under the receiver operating characteristic curve: 0.741vs 0.722; p = 0.92), and a highly prognostic cut-off for discriminating (15.98 s). This cut-off had higher likelihood ratios (LRs) than the 6MWT cut-off (∼350 m), especially for negative LRs (1/LR-: 7.69vs 2.00).
The 5-STS is an objective measure for predicting mortality in patients with COPD and has good discriminative ability, with a cut-off for discriminating survival slight better than the 6MWT. The prognostic value of the other tests remains to be confirmed.
预后研究表明，一些肌肉骨骼和功能能力测试与慢性阻塞性肺疾病（COPD）患者的死亡率独立相关，但由于这些研究中回归模型中选择的协变量不同，比较其预后价值较为困难。
评估五项肌肉骨骼和功能能力测试在调整现有和混杂的预后因素后预测 COPD 患者死亡风险的预后价值，并比较使用 6 分钟步行测试（6MWT）对个体参与者死亡率的正确区分能力。我们假设所检查的测试具有不同的预后价值。
前瞻性和纵向研究。2014 年，我们从西班牙的一家医院招募了 137 名稳定期 COPD 患者（平均[标准差]年龄 67[8.33]岁；87%为男性），并对其进行了 5 年（2014-2019 年）随访。没有人拒绝，只有一人失访。主要结局指标为 5 年全因死亡率。
共有 37 例患者在 5 年内死亡。在 Cox 比例风险回归模型中，所有肌肉骨骼测试均与 5 年全因死亡率相关。然而，只有五重复坐立测试（5-STS）评分是调整心脏病史、既往严重加重次数和呼吸困难后独立的预后因素（每增加 1 秒，风险比为 1.04，95%置信区间为 1.01-1.08）。该模型解释了死亡率方差的 50.7%。该测试对 5 年死亡率的预测能力与 6MWT 相似（受试者工作特征曲线下面积：0.741 与 0.722；p=0.92），并且在区分（15.98s）方面具有较高的截断值。该截断值的似然比（LR）高于 6MWT 截断值（~350m），尤其是负 LR（1/LR-：7.69 与 2.00）。
5-STS 是预测 COPD 患者死亡率的客观指标，具有良好的区分能力，其区分生存的截断值略优于 6MWT。其他测试的预后价值仍有待证实。
