Budweiser, Stephan and Jorres, Rudolf A. and Riedl, Theresa and Heinemann, Frank and Hitzl, Andre P. and Windisch, Wolfram and Pfeifer, Michael (2007) Predictors of survival in COPD patients with chronic hypercapnic respiratory failure receiving noninvasive home ventilation. CHEST, 131 (6). pp. 1650-1658. ISSN 0012-3692,
Full text not available from this repository. (Request a copy)Abstract
Background: Patients with COPD and chronic hypercapnic respiratory failure (CHRF) are at high risk, and noninvasive ventilation at home is increasingly being used. Knowledge of prognostic parameters under these conditions is limited but may be clinically helpful and highlight the role of noninvasive ventilation. Methods: In 188 patients with COPD (mean +/- SD FEV, 31.0 +/- 9.6% of predicted; PaCO2, 56.3 +/- 9.4 mm Hg) discharged from the hospital receiving NIV between July 1994 and July 2004, the prognostic value of body mass index (BMI), lung function, laboratory parameters, and blood gas levels was assessed by univariate and multivariate Cox regression analyses. Moreover, the impact of changes in risk factors on mortality assessed 6.7 +/- 2.8 months after the initiation of noninvasive ventilation was evaluated. Results: Overall, the mortality rate during follow-up (duration, 32.2 +/- 24.3 months) was 44.7%, with 1-year, 2-year, and 5-year survival rates of 84.0%, 65.3%, and 26.4%. Deaths resulted predominantly from respiratory causes (73.8%). Univariate regression analyses revealed age, BMI, hemoglobin, FEV, specific airway resistance, residual volume (RV)/total lung capacity (TLC), pH, and base excess (BE) to be associated with prognosis (p < 0.01 each), whereas multivariate analysis identified only age, BMI, RV/TLC, and BE as independent predictors (p < 0.05). In patients at risk (BMI < 25 km/m(2), RV/TLC >= 73%, or BE >= 9 mmol/L), changes in these predictors were also associated with survival. Conclusions: In patients with COPD and CHRF, nutritional status, hyperinflation, and BE, which turned out to be reliable and consistent markers in CHRF, were independent prognostic factors for mortality. These data favor a multidimensional approach in these patients, including the use of noninvasive ventilation.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | OBSTRUCTIVE PULMONARY-DISEASE; POSITIVE-PRESSURE VENTILATION; DOMICILIARY OXYGEN-THERAPY; AIR-FLOW OBSTRUCTION; HYPOXIC COR-PULMONALE; TERM-FOLLOW-UP; MECHANICAL VENTILATION; STABLE COPD; NUTRITIONAL DEPLETION; EXERCISE CAPACITY; chronic respiratory failure; COPD; mortality; noninvasive ventilation; prognostic factors |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 09 Dec 2020 06:12 |
| Last Modified: | 11 Jan 2021 08:17 |
| URI: | https://pred.uni-regensburg.de/id/eprint/32643 |
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