Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy - Data from the ANTADIR Observatory
Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy - Data from the ANTADIR Observatory
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DOI：
10.1378/chest.123.5.1460
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发表时间：
2003-05-01
期刊：
影响因子：
9.6
通讯作者：
Veale, D
中科院分区：
文献类型：
--
作者：
Chailleux, E;Laaban, JP;Veale, D
背景资料：体重下降和死亡率之间的关联已在COPD患者中得到证实，但营养不良对接受家庭长期氧疗（LTOT）治疗的最严重COPD患者的预后影响尚未得到评估。研究目的：分析接受LTOT治疗的COPD患者营养下降对生存率和住院率的预后价值。设计：对国家数据库的分析（慢性呼吸功能不全家庭治疗协会观察站[ANTAORA]）。背景：20世纪80年代在法国成立的慢性呼吸功能不全患者家庭治疗国家非营利网络（ANTAORA）。患者：1984年至1993年期间，共有4，088例诊断为慢性支气管炎或肺气肿，FEVI/肺活量比值<60%，Pao（2）< 8 kPa，并接受LTOT治疗的患者。按体重指数< 20定义，营养不良的发生率在男子中为23%，在妇女中为30%。BMI与FEV 1、FEV 1/VC显著相关。平均随访时间为7.5年。BMI < 20、20 - 24、25 - 29和≥ 30的患者的5年生存率分别为24%、34%、44%和59%。采用考克斯模型的多变量分析表明，BMI对生存率的影响与年龄、FEV 1、Pao 2和性别无关。较低的BMI是住院时间和住院率的最有力的预测因子，独立于血气水平和呼吸功能。BMI < 20的患者平均（+/-SD）年住院时间为29.6+/-40.4天，BMI > 30的患者为17.5+/-30.1天。结论：本研究表明，营养缺乏是COPD患者接受LTOT时死亡和住院的独立危险因素。超重和肥胖患者的预后最好。
Background: An association between weight depletion and mortality has been demonstrated in patients with COPD, but the prognostic influence of malnutrition has not been evaluated in patients with the most severe COPD treated with home long-term oxygen therapy (LTOT).Study objective: To analyze the prognostic value of nutritional depletion in patients with COPD receiving LTOT with respect to survival and hospitalization rate.Design: Analysis of a national database (Observatory of Association Nationale pour le Traitement a Domicile de l'Insuffisance Respiratoire Chronique [ANTADIR]).Setting: The national nonprofit network for home treatment of patients with chronic respiratory insufficiency (ANTADIR) founded in France in the 1980s.Patients: A total of 4,088 patients with a diagnosis of chronic bronchitis or emphysema, FEVI/vital capacity ratio < 60%, Pao(2) < 8 kPa, and treatment with LTOT between 1984 and 1993.Measurements and results: The prevalence of malnutrition, as defined by a body mass index (BMI) < 20, was 23% in men and 30% in women. BMI was significantly correlated with FEV1 and FEV1/VC. The mean follow-up duration was 7.5 years. The 5-year survival rates were 24%, 34%, 44%, and 59%, respectively, for patients with BMIs < 20, 20 to 24, 25 to 29, and greater than or equal to 30. Multivariate analysis using the Cox model demonstrated that the effect of BMI on survival was independent of age, FEV1, Pao2, and sex. Lower BMI was the most powerful predictor of duration and rate of hospitalization, independently of blood gas levels and respiratory function. The mean (+/-SD) annual time spent in the hospital was 29.6+/-40.4 days for patients with a BMI < 20 vs 17.5+/-30.1 days for patients with a BMI > 30.Conclusion: This study showed that nutritional depletion is an independent risk factor for mortality and hospitalization in patients with COPD receiving LTOT. The best prognosis was observed in overweight and obese patients.