Survival in pulmonary hypertension due to chronic lung disease: Influence of low diffusion capacity of the lungs for carbon monoxide.
Survival in pulmonary hypertension due to chronic lung disease: Influence of low diffusion capacity of the lungs for carbon monoxide.
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DOI：
10.1016/j.healun.2018.09.011
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发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Thenappan T
中科院分区：
文献类型：
--
作者：
Rose L;Prins KW;Archer SL;Pritzker M;Weir EK;Misialek JR;Thenappan T
慢性肺病导致的肺动脉高压 (PH) 患者（第 3 组 PH）的长期预后较差。然而，第 3 组 PH 的生存预测因素尚未得到很好的描述。我们对明尼苏达大学的第 3 组 PH 患者（n = 143；平均年龄 65 ± 12 岁，52% 女性）进行了队列研究。 Kaplan-Meier 方法和 Cox 回归分析分别用于评估生存率和死亡率预测因子。根据世界卫生组织 (WHO) 分类和肺部疾病病因学，对根据 PH 严重程度进行分类的患者的临床特征和生存率进行比较。中位随访 1.4 年后，有 69 人 (48%) 死亡。 1年、3年和5年生存率分别为79%、48%和31%。年龄、冠状动脉疾病、心房颤动、查尔森合并症指数、血清N末端脑钠肽前体（NT-proBNP）、肌酐、一氧化碳弥散能力（DLCO）、肺总量、左心室射血分数、超声心动图右心房和右心室扩大、心脏指数和肺血管阻力（PVR）是生存的单变量预测因子。在多变量分析中，DLCO 是死亡率的唯一预测因子（预测值每下降 10%，调整后的风险比 [HR]：1.31 [95% 置信区间 1.12 至 1.47]；p = 0.003）。 DLCO 三分位数的 1 年/5 年生存率分别为 84%/56%、82%/44% 和 63%/14% (p = 0.01)。在接受者操作特征曲线分析中，DLCO < 预测值的 32% 对于预测生存具有最高的敏感性和特异性。 DLCO ≥ 32% 预测的患者的 1 年和 5 年生存率分别为 84% 和 60%，而 DLCO < 32% 预测的患者的 1 年和 5 年生存率分别为 68% 和 13%（调整后的 HR：2.5 [95% 置信区间 1.3 至 5.0]；p = 0.007）。肺容量和 DLCO 不相关，但较高的 PVR 与减少的 DLCO 密切相关。与慢性阻塞性肺疾病 PH 相比，间质性肺疾病 PH 的死亡率增加，但根据 WHO 分类的 PH 严重程度并没有改变生存率。低 DLCO 是死亡率的预测因子，应用于对 3 组 PH 患者进行风险分层。
Patients with pulmonary hypertension (PH) due to chronic lung disease (Group 3 PH) have poor long-term outcomes. However, predictors of survival in Group 3 PH are not well described. We performed a cohort study of Group 3 PH patients (n = 143; mean age 65 ± 12 years, 52% female) evaluated at the University of Minnesota. The Kaplan–Meier method and Cox regression analysis were used to assess survival and predictors of mortality, respectively. The clinical characteristics and survival were compared in patients categorized by PH severity based on the World Health Organization (WHO) classification and lung disease etiology. After a median follow-up of 1.4 years, there were 69 (48%) deaths. The 1-, 3-, and 5-year survival rates were 79%, 48%, and 31%. Age, coronary artery disease, atrial fibrillation, Charlson comorbidity index, serum N-terminal pro‒brain natriuretic peptide (NT-proBNP), creatinine, diffusion capacity of carbon monoxide (DLCO), total lung capacity, left ventricular ejection fraction, right atrial and right ventricular enlargement on echocardiography, cardiac index, and pulmonary vascular resistance (PVR) were univariate predictors of survival. On multivariable analysis, DLCO was the only predictor of mortality (adjusted hazard ratio [HR] for every 10% decrease in predicted value: 1.31 [95% confidence interval 1.12 to 1.47]; p = 0.003). The 1-/5-year survival by tertiles of DLCO was 84%/56%, 82%/44%, and 63%/14% (p = 0.01), respectively. On receiver-operating characteristic curve analysis, DLCO < 32% of predicted had the highest sensitivity and specificity for predicting survival. The 1- and 5-year survival in patients with a DLCO ≥ 32% predicted was 84% and 60% vs 68% and 13% in patients with a DLCO < 32% predicted (adjusted HR: 2.5 [95% confidence interval 1.3 to 5.0]; p = 0.007). Lung volumes and DLCO were not related, but higher PVR was strongly associated with reduced DLCO. There was increased mortality in interstitial lung disease‒PH as compared with chronic obstructive pulmonary disease‒PH, but PH severity based on the WHO classification did not alter survival. Low DLCO is a predictor of mortality and should be used to risk-stratify Group 3 PH patients.
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