Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Spain.
Respiratory Department, Hospital Universitario La Paz, IdiPaz, Spain; CIBERes, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
Respir Med. 2024 Apr-May;225:107597. doi: 10.1016/j.rmed.2024.107597. Epub 2024 Mar 16.
To assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients.
A cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation.
58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5-14.8 vs. 7.2; 95% CI, 7.1-7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010-8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385-11.328), and dynamic hyperinflation, FEV and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087-2.581).
In stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.
评估动态过度充气是否是 COPD 患者死亡和严重加重的独立危险因素。
对一组 141 例稳定期 COPD 患者进行了研究，这些患者有中到重度气流受限，按照常规指南进行了治疗。中位随访时间为 9 年。记录临床特征，并进行动脉血气、肺功能检查、6 分钟步行和递增运动试验，测量呼吸模式和手术肺容积。终点是全因死亡率和 COPD 加重住院率。
在随访期间，有 58 例患者死亡（1228 例患者×年）。有动态过度充气的患者（n=106）死亡率高于没有动态过度充气的患者（n=35）（14.6；95%CI，14.5-14.8 比 7.2；95%CI，7.1-7.4 每 1000 例患者年）。在校正性别、年龄、体重指数、吸烟指数和吸入皮质激素治疗后，动态过度充气与更高的死亡风险相关（校正后的危害比[aHR]，2.725；95%CI，1.010-8.161），在多变量模型中，合并症、峰值摄氧量和动态过度充气被保留为死亡的独立预测因子。有动态过度充气的患者首次严重加重的时间更短（aHR，3.961；95%CI，1.385-11.328），并且动态过度充气、FEV 和弥散量被保留为严重加重的独立危险因素。此外，有动态过度充气的患者住院风险高于没有动态过度充气的患者（校正后的发病率比[aIRR]，1.574；95%CI，1.087-2.581）。
在稳定期 COPD 患者中，动态过度充气是死亡和严重加重的独立预后因素。
