Six-Minute-Walk Distance and Accelerometry Predict Outcomes in Chronic Obstructive Pulmonary Disease Independent of Global Initiative for Chronic Obstructive Lung Disease 2011 Group
Six-Minute-Walk Distance and Accelerometry Predict Outcomes in Chronic Obstructive Pulmonary Disease Independent of Global Initiative for Chronic Obstructive Lung Disease 2011 Group
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DOI：
10.1513/annalsats.201408-365oc
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发表时间：
2015-03-01
影响因子：
8.3
通讯作者：
Blumenthal, James A.
中科院分区：
文献类型：
--
作者：
Durheim, Michael T.;Smith, Patrick J.;Blumenthal, James A.
理由：2011年慢性阻塞性肺疾病全球倡议（GOLD）联合评估纳入了慢性阻塞性肺疾病（COPD）患者的症状、加重史和肺活量测定来区分加重风险。6分钟步行距离（6MWD）和加速度计也被用于评估COPD的疾病严重程度。在GOLD 2011的背景下，这些措施与住院和死亡风险之间的关联尚不清楚。目的：描述COPD患者运动耐量和体力活动随时间的变化，并检验较低的基线6MWD或加速度计步数与COPD相关住院或全因死亡风险增加相关的假设，独立于GOLD 2011组。方法：在应对技能训练干预的INSPIRE-H随机对照试验中，对326例中重度COPD患者的身体功能和医疗结果进行前瞻性评估。使用Cox模型来确定GOLD 2011组、6MWD或加速度计步数是否与copd相关住院或全因死亡风险相关。测量结果和主要结果：GOLD组D的身体功能随着时间的推移而下降，但在A、B和c组保持稳定。GOLD分类与死亡时间或首次copd相关住院有关。与2011年GOLD分类相比，基线6MWD与死亡时间或首次copd相关住院的相关性更强（风险比为0.50[95%可信区间，0.34,0.73]/ 150 m, P = 0.0003）。在加速计步数中也观察到类似的关系（每1000步的风险比为0.80[95%置信区间，0.70,0.92],P = 0.002）。结论：运动耐量和日常体力活动是COPD住院和死亡率的重要预测因素，独立于GOLD 2011分类。身体功能可能是一个可改变的危险因素，值得更多的关注，作为干预的目标，以改善COPD临床有意义的结果。
Rationale: The 2011 combined Global Initiative for Chronic Obstructive Lung Disease (GOLD) assessment incorporates symptoms, exacerbation history, and spirometry in discriminating risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Six-minute-walk distance (6MWD) and accelerometry also have been used to assess disease severity in COPD. The association between these measures and the risks of hospitalization and mortality in the context of GOLD 2011 is unknown.Objectives: To describe changes in exercise tolerance and physical activity over time in patients with COPD and to test the hypothesis that lower baseline 6MWD or accelerometry step count is associated with increased risk of COPD-related hospitalization or all-cause mortality, independent of GOLD 2011 group.Methods: Physical function and medical outcomes were prospectively assessed in 326 patients with moderate to severe COPD in INSPIRE-H, a randomized controlled trial of a coping skills training intervention. Cox models were used to determine if GOLD 2011 group, 6MWD, or accelerometry steps were associated with risk of COPD-related hospitalization or all-cause mortality.Measurements and Main Results: Physical function declined over time in GOLD group D but remained stable in groups A, B, and C. GOLD classification was associated with time to death or first COPD-related hospitalization. Baseline 6MWD was more strongly associated with time to death or first COPD-related hospitalization (hazard ratio, 0.50 [95% confidence interval, 0.34, 0.73] per 150 m, P = 0.0003) than GOLD 2011 classification. A similar relationship was observed for accelerometry steps (hazard ratio, 0.80 [95% confidence interval, 0.70, 0.92] per 1,000 steps, P = 0.002).Conclusions: Exercise tolerance and daily physical activity are important predictors of hospitalization and mortality in COPD, independent of GOLD 2011 classification. Physical function may represent a modifiable risk factor that warrants increased attention as a target for interventions to improve clinically meaningful outcomes in COPD.