Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

Fernando J. Martinez; Gregory Foster; Jeffrey L. Curtis; Gerard Criner; Gail Weinmann; Alfred Fishman; Malcolm M. DeCamp; Joshua Benditt; Frank Sciurba; Barry Make; Zab Mohsenifar; Philip Diaz; Eric Hoffman; Robert Wise; National Emphysema Treatment Trial (NETT) Research Group

doi:10.1164/rccm.200510-1677OC

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Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

Journal article

Open access

Peer reviewed

Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

Fernando J. Martinez, Gregory Foster, Jeffrey L. Curtis, Gerard Criner, Gail Weinmann, Alfred Fishman, Malcolm M. DeCamp, Joshua Benditt, Frank Sciurba, Barry Make, …

American journal of respiratory and critical care medicine, Vol.173(12), pp.1326-1334

03/16/2006

DOI: 10.1164/rccm.200510-1677OC

PMCID: PMC2662972

PMID: 16543549

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Abstract

Purpose: Limited data exist describing risk factors for mortality in patients having predominantly emphysema. Subjects and Methods: A total of 609 patients with severe emphysema (ages 40–83 yr; 64.2% male) randomized to the medical therapy arm of the National Emphysema Treatment Trial formed the study group. Cox proportional hazards regression analysis was used to investigate risk factors for all-cause mortality. Risk factors examined included demographics, body mass index, physiologic data, quality of life, dyspnea, oxygen utilization, hemoglobin, smoking history, quantitative emphysema markers on computed tomography, and a modification of a recently described multifunctional index (modified BODE). Results: Overall, high mortality was seen in this cohort (12.7 deaths per 100 person-years; 292 total deaths). In multivariate analyses, increasing age (p = 0.001), oxygen utilization (p = 0.04), lower total lung capacity % predicted (p = 0.05), higher residual volume % predicted (p = 0.04), lower maximal cardiopulmonary exercise testing workload (p = 0.002), greater proportion of emphysema in the lower lung zone versus the upper lung zone (p = 0.005), and lower upper-to-lower-lung perfusion ratio (p = 0.007), and modified BODE (p = 0.02) were predictive of mortality. FEV 1 was a significant predictor of mortality in univariate analysis (p = 0.005), but not in multivariate analysis (p = 0.21). Conclusion: Although patients with advanced emphysema experience significant mortality, subgroups based on age, oxygen utilization, physiologic measures, exercise capacity, and emphysema distribution identify those at increased risk of death.

Computed Tomography

A. Chronic Obstructive Pulmonary Disease

chronic obstructive pulmonary disease

mortality

prognosis

pulmonary function

Details

Title: Subtitle: Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction
Creators: Fernando J. Martinez - University of Michigan–Ann Arbor
Gregory Foster
Jeffrey L. Curtis
Gerard Criner
Gail Weinmann
Alfred Fishman
Malcolm M. DeCamp - Surgery, Thoracic Surgery Division
Joshua Benditt
Frank Sciurba
Barry Make
Zab Mohsenifar
Philip Diaz
Eric Hoffman
Robert Wise
National Emphysema Treatment Trial (NETT) Research Group
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.173(12), pp.1326-1334
Publisher: American Thoracic Society
DOI: 10.1164/rccm.200510-1677OC
PMID: 16543549
PMCID: PMC2662972
ISSN: 1073-449X
eISSN: 1535-4970
Language: English
Date published: 03/16/2006
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984318714002771

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