Diffusing Capacity Is an Independent Predictor of Outcomes in Pulmonary Hypertension Associated With COPD
Diffusing Capacity Is an Independent Predictor of Outcomes in Pulmonary Hypertension Associated With COPD
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DOI：
10.1016/j.chest.2020.02.047
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发表时间：
2020-08-01
期刊：
影响因子：
9.6
通讯作者：
Mathai, Stephen C.
中科院分区：
文献类型：
--
作者：
Balasubramanian, Aparna;Kolb, Todd M.;Mathai, Stephen C.
背景：COPD合并肺动脉高压（PH）患者的死亡率比单纯COPD患者更高。COPD-PH不良结局的预测因素尚未得到很好的描述。肺弥散功能（DLCO）评估肺泡毛细血管界面的完整性，因此可能是COPD-PH患者的有用预后工具。研究问题：使用单中心登记，我们试图评估DLCO作为COPD-PH患者队列死亡率的预测因子。研究设计和方法：这项回顾性队列研究分析了来自约翰霍普金斯肺动脉高压登记处的71例接受右侧心脏导管插入术（RHC）的COPD-PH患者。在诊断性RHC的一年内获得经证实的PH和肺功能测试数据。无移植存活率由指数RHC计算。校正后的无移植生存率采用考克斯比例风险法建模;年龄、肺血管阻力、FEV 1、氧耗和N末端脑钠肽前体作为协变量。结果：总体未校正的无移植1年、3年和5年生存率分别为87%、60%和51%。在观察到的肺动脉压和肺血管阻力范围内，生存率与DLCO降低相关。严重DLCO损伤与生存率降低相关（对数秩卡方检验（2）13.07）（P < .001）;调整协变量，DLCO每降低一个百分比，死亡率增加4%（风险比，1.04; 95% CI，1.01-1.07）。在COPD-PH患者中，严重的气体转移障碍与较高的死亡率相关，即使调整了气流阻塞和血流动力学，这表明DLCO可能是该人群中有用的预后标志物。未来的研究需要进一步研究DLCO和发病率之间的关系，并确定DLCO作为COPD-PH疾病风险和严重程度的生物标志物的效用。
BACKGROUND: Patients with COPD who experience pulmonary hypert ension (PH) have worse mortality than those with COPD alone. Predictors of poor outcomes in COPD-PH are not well-described. Diffusing capacity of the lung (DLCO) assesses the integrity of the alveolar capillary interface and thus may be a useful prognostic tool among those with COPD-PH.RESEARCH QUESTION: Using a single center registry, we sought to evaluate DLCO as a predictor of mortality in a cohort of patients with COPD-PH.STUDY DESIGN AND METHODS: This retrospective cohort study analyzed 71 COPD-PH patients from the Johns Hopkins Pulmonary Hypertension Registry with right-sided heart catheterization (RHC)-proven PH and pulmonary function testing data within one year of diagnostic RHC. Transplant-free survival was calculated from index RHC. Adjusted transplant-free survival was modelled using Cox proportional hazard methods; age, pulmonary vascular resistance, FEV1, oxygen use, and N-terminal pro-brain natriuretic peptide were included as covariates.RESULTS: Overall unadjusted transplant-free 1-, 3-, and 5-year survivals were 87%, 60%, and 51%, respectively. Survival was associated with reduced DLCO across the observed range of pulmonary artery pressures and pulmonary vascular resistance. Severe DLCO impairment was associated with poorer survival (log-rank chi(2) 13.07) (P < .001); adjusting for covariates, for every percent predicted decrease in DLCO, mortality rates increased by 4% (hazard ratio, 1.04; 95% CI, 1.01-1.07).INTERPRETATION: Among patients with COPD-PH, severe gas transfer impairment is associated with higher mortality, even with adjustment for airflow obstruction and hemodynamics, which suggests that DLCO may be a useful prognostic marker in this population. Future studies are needed to further investigate the association between DLCO and morbidity and to determine the utility of DLCO as a biomarker for disease risk and severity in COPD-PH.