慢性阻塞性肺疾病的长期无创通气：临床表型与生存的关联。

Long-Term Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: Association between Clinical Phenotypes and Survival.

机构信息

Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.

Faculty of Medicine, University of Geneva, Geneva, Switzerland.

出版信息

Respiration. 2022;101(10):939-947. doi: 10.1159/000525865. Epub 2022 Aug 26.

DOI:10.1159/000525865

PMID:36030774

Abstract

BACKGROUND

Long-term noninvasive ventilation (LTNIV) is widely used in patients with chronic hypercapnic respiratory failure (CHRF) related to COPD. Prognosis of these patients is however poor and heterogenous.

RESEARCH QUESTION

In COPD patients under LTNIV for CHRF, is it possible to identify specific phenotypes which are predictive of probability of pursuing NIV and survival?

STUDY DESIGN AND METHODS

A latent class analysis was performed in a COPD population under LTNIV included in a comprehensive database of patients in the Geneva Lake area, to determine clinically relevant phenotypes. The observation period of this subgroup of COPD was extended to allow assessment of survival and/or pursuit of NIV for at least 2 years after inclusion. A logistic regression was conducted to generate an equation accurately attributing an individual patient to a defined phenotype. The identified phenotypes were compared on a series of relevant variables, as well as for probability of pursuing NIV or survival. A competitive risk analysis allowed to distinguish death from other causes of cessation of NIV.

RESULTS

Two phenotypes were identified: a "respiratory COPD" profile with very severe airway obstruction, a low or normal body mass index, and a low prevalence of comorbidities and a "systemic COPD" profile of obese COPDs with moderate airway obstruction and a high rate of cardiovascular and metabolic comorbidities. The logistic regression correctly classified 95.7% of patients studied. Probability of pursuing NIV and survival were significantly related to these phenotypes, with a poorer prognosis for "respiratory COPD." Probability of death 5 years after implementing NIV was 22.3% (95% CI: 15.4-32.2) for "systemic COPD" versus 47.2% (37.4-59.6) for "respiratory COPD" (p = 0.001).

CONCLUSION

The two distinct phenotypes of COPD under LTNIV for CHRF identified appear to be strongly related to prognosis and require further validation in other cohort studies.

摘要

背景

长期无创通气（LTNIV）广泛应用于慢性高碳酸血症呼吸衰竭（CHRF）相关的 COPD 患者。然而，这些患者的预后较差且存在异质性。

研究问题

在接受 LTNIV 治疗 CHRF 的 COPD 患者中，是否可以确定特定的表型，这些表型可以预测继续接受 NIV 治疗的可能性和生存？

研究设计和方法

对接受 LTNIV 治疗的 COPD 患者进行潜在类别分析，该患者纳入了日内瓦湖区患者综合数据库。确定具有临床意义的表型。该 COPD 亚组的观察期延长，以评估至少 2 年后的生存和/或继续接受 NIV 治疗的可能性。进行逻辑回归，以生成一个能够准确将个体患者分配到特定表型的方程。比较所确定的表型在一系列相关变量上的差异，以及继续接受 NIV 治疗或生存的可能性。竞争风险分析用于区分死亡和其他停止 NIV 的原因。

结果

确定了两种表型：一种是“呼吸型 COPD”，表现为严重气道阻塞、低或正常体重指数和低合并症发生率；另一种是“全身型 COPD”，表现为中度气道阻塞和高心血管和代谢合并症发生率的肥胖 COPD。逻辑回归正确分类了 95.7%的研究患者。继续接受 NIV 治疗的可能性和生存与这些表型显著相关，“呼吸型 COPD”的预后较差。实施 NIV 治疗后 5 年，“全身型 COPD”的死亡率为 22.3%（95%CI：15.4-32.2），而“呼吸型 COPD”为 47.2%（37.4-59.6）（p=0.001）。