Physical Activity Is the Strongest Predictor of All-Cause Mortality in Patients With COPD A Prospective Cohort Study
Physical Activity Is the Strongest Predictor of All-Cause Mortality in Patients With COPD A Prospective Cohort Study
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DOI：
10.1378/chest.10-2521
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发表时间：
2011-08-01
期刊：
影响因子：
9.6
通讯作者：
Magnussen, Helgo
中科院分区：
文献类型：
--
作者：
Waschki, Benjamin;Kirsten, Anne;Magnussen, Helgo
背景：COPD的全身效应不能完全通过已建立的预后评估来反映。我们确定了客观测量的体力活动的预后价值，并与已建立的死亡率预测因子进行了比较，并评估了心血管状态、全身炎症生物标志物和脂肪因子的无创评估的预后价值。（平均FEY 56%预测值），我们通过肺量测定法和身体体积描记法评估肺功能，通过多感觉臂带评估体力活动水平（PAL），通过6分钟步行距离试验评估运动能力，通过超声心动图、血管多普勒超声检查（踝臂指数[ABI]和N-末端B型利钠肽前体水平）评估心血管状态;通过BMI和去脂肪质量指数评估营养和肌肉状态;通过高敏C反应蛋白、IL-6、纤维蛋白原、脂联素和瘦素水平评估生物标志物;健康状况、呼吸困难和抑郁症状。建立预后指数进行了计算。结果：全因死亡率为15.4%。校正后，PAL每增加0.14与死亡风险降低相关（风险比[HR]，0.46; 95%CI，0.33-0.64; P <0.001）。与已建立的预测因子相比，PAL显示出4年生存率的最佳判别特性（C统计量，0.81），并且与每标准化下降的最高相对死亡风险相关。新的死亡率预测因子是脂联素水平（HR，1.34; 95% CI，1.06-1.71; P = .017），瘦素水平（HR，0.81; 95% CI，0.65-0.99; P = 0.042），右心室功能（Tei指数）（HR，1.26; 95%CI，1.04-1.54; P = .020）和ABI < 1.00（HR，3.87; 95%CI，1.44-10.40; P = .007）。逐步考克斯回归分析显示，PAL、脂联素水平和ABI是独立预测因子的最佳模型。这些因素的复合进一步提高了判别属性（C统计，0.85）。结论：我们发现，客观测量的体力活动是最强的预测COPD患者的全因死亡率。此外，脂联素水平和血管状态在我们的队列中提供独立的预后信息。胸部2011; 140（2）：331-342
Background: Systemic effects of COPD are incompletely reflected by established prognostic assessments. We determined the prognostic value of objectively measured physical activity in comparison with established predictors of mortality and evaluated the prognostic value of noninvasive assessments of cardiovascular status, biomarkers of systemic inflammation, and adipokines.Methods: In a prospective cohort study of 170 outpatients with stable COPD (mean FEY 56% predicted), we assessed lung function by spirometry and body plethysmography; physical activity level (PAL) by a multisensory armband; exercise capacity by 6-min walk distance test; cardiovascular status by echocardiography, vascular Doppler sonography (ankle-brachial index [ABI, and N-terminal pro-B-type natriuretic peptide level; nutritional and muscular status by BMI and fat-free mass index; biomarkers by levels of high-sensitivity C-reactive protein, IL-6, fibrinogen, adiponectin, and leptin; and health status, dyspnea, and depressive symptoms by questionnaire. Established prognostic indices were calculated. The median follow-up was 48 months (range, 10-53 months).Results: All-cause mortality was 15.4%. After adjustments, each 0.14 increase in PAL was associated with a lower risk of death (hazard ratio [HR], 0.46; 95% CI, 0.33-0.64; P < .001). Compared with established predictors, PAL showed the best discriminative properties for 4-year survival (C statistic, 0.81) and was associated with the highest relative risk of death per standardized decrease. Novel predictors of mortality were adiponectin level (HR, 1.34; 95% CI, 1.06-1.71; P = .017), leptin level (HR, 0.81; 95% CI, 0.65-0.99; P =.042), right ventricular function (Tei-index) (HR, 1.26; 95% CI, 1.04-1.54; P = .020), and ABI < 1.00 (HR, 3.87; 95% CI, 1.44-10.40; P = .007). A stepwise Cox regression revealed that the best model of independent predictors was PAL, adiponectin level, and ABI. The composite of these factors further improved the discriminative properties (C statistic, 0.85).Conclusions: We found that objectively measured physical activity is the strongest predictor of all-cause mortality in patients with COPD. In addition, adiponectin level and vascular status provide independent prognostic information in our cohort. CHEST 2011; 140(2):331-342