Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients
Long-term adherence with non-invasive ventilation improves prognosis in obese COPD patients
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DOI：
10.1111/resp.12327
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发表时间：
2014-08-01
期刊：
影响因子：
6.9
通讯作者：
Timsit, Jean-Francois
中科院分区：
文献类型：
--
作者：
Borel, Jean-Christian;Pepin, Jean-Louis;Timsit, Jean-Francois
背景和目的：长期无创通气（NIV）已成为慢性阻塞性肺疾病（COPD）合并慢性呼吸衰竭患者的广泛治疗方式。然而，就患者相关结果而言的益处仍在争论中。 NIV 依从性和不同 COPD 表型的异质反应可能导致难以证明 NIV 益处。我们的目的是评估 NIV 依从性对急性加重住院率和死亡的影响。方法：这是一项针对接受长期 NIV 治疗的 COPD 患者的前瞻性多中心队列研究。研究纳入时收集了合并症、人体测量学、呼吸参数。随访数据包括生命状态、NIV 依从性和住院情况。使用调整后的 Cox 模型测试 NIV 依从性对预后的影响。还对肥胖和非肥胖 COPD 亚型进行了敏感性分析。结果：纳入了 213 名患者（48% 肥胖），其中 45.5% 在 47.7 年间死亡 [四分位距 = 27.8；四分位距 = 27.8]。 73]几个月的随访。肥胖慢性阻塞性肺病患者的生存率高于非肥胖慢性阻塞性肺病患者。每天使用 NIV > 9 小时与死亡或因急性加重住院的风险增加相关 [HR = 1.6； 95CI：1.1-2.4]。在肥胖 COPD 中，这种风险描述了从 > 1 小时/天到 > 9 小时/天 NIV 使用的 U 形曲线，当 NIV 坚持 > 5 小时/天时，预后有所改善 [HR = 0.5; 95CI：0.2-0.9]。结论：仅在肥胖 COPD 中，坚持 NIV 与更好的预后相关。 NIV 使用 > 9 小时/天预示着不良结果。
Background and objective: Long-term non-invasive ventilation (NIV) has become a widespread modality of treatment in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. However, benefits in terms of patient-related outcomes are still under debate. Both NIV adherence and heterogeneous responses in different COPD phenotypes may contribute to the difficulty of demonstrating NIV benefits. Our aim was to assess the impact of NIV adherence on the rate of hospitalization for acute exacerbation and death.Methods: This is a prospective multi-centre cohort study of COPD patients treated by long-term NIV. Comorbidities, anthropometrics, respiratory parameters were collected at inclusion in the study. Follow-up data included vital status, NIV adherence and hospitalizations. The influence of NIV adherence on prognosis was tested using an adjusted Cox model. Sensitivity analyses for obese and non-obese COPD subtypes were also conducted.Results: Two hundred thirteen patients (48% obese) were included with 45.5% died during 47.7 [interquartile range = 27.8; 73] months' follow-up. Survival was better in obese COPD than non-obese COPD. The use of NIV > 9 h/day was associated with an increased risk of death or hospitalization for acute exacerbation [HR = 1.6; 95CI: 1.1-2.4]. In obese COPD, this risk described a U-shaped curve from > 1 to > 9 h/day NIV usage with an improvement in prognosis when NIV adherence was > 5 h/day [HR = 0.5; 95CI: 0.2-0.9].Conclusions: Adherence to NIV was associated with better prognosis only in obese COPD. NIV use > 9 h/day predicted poor outcomes.