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Lung function indices for predicting mortality in COPD

Afroditi K. Boutou, Dinesh Shrikrishna, Rebecca J. Tanner, Cayley Smith, Julia L. Kelly, Simon P. Ward, Michael I. Polkey, Nicholas S. Hopkinson
European Respiratory Journal 2013 42: 616-625; DOI: 10.1183/09031936.00146012
Afroditi K. Boutou
1NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
2Respiratory Failure Unit, Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Dinesh Shrikrishna
1NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Rebecca J. Tanner
1NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Cayley Smith
1NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Julia L. Kelly
1NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Simon P. Ward
1NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Michael I. Polkey
1NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Nicholas S. Hopkinson
1NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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  • For correspondence: n.hopkinson@ic.ac.uk
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Abstract

Chronic obstructive pulmonary disease (COPD) is characterised by high morbidity and mortality. It remains unknown which aspect of lung function carries the most prognostic information and if simple spirometry is sufficient.

Survival was assessed in COPD outpatients whose data had been added prospectively to a clinical audit database from the point of first full lung function testing including spirometry, lung volumes, gas transfer and arterial blood gases. Variables univariately associated with survival were entered into a multivariate Cox proportional hazard model.

604 patients were included (mean±sd age 61.9±9.7 years; forced expiratory volume in 1 s 37±18.1% predicted; 62.9% males); 229 (37.9%) died during a median follow-up of 83 months. Median survival was 91.9 (95% CI 80.8–103) months with survival rates at 3 and 5 years 0.83 and 0.66, respectively. Carbon monoxide transfer factor % pred quartiles (best quartile (>51%): HR 0.33, 95% CI 0.172–0.639; and second quartile (51–37.3%): HR 0.52, 95% CI 0.322–0.825; versus lowest quartile (<27.9%)), age (HR 1.04, 95% CI 1.02–1.06) and arterial oxygen partial pressure (HR 0.85, 95% CI 0.77–0.94) were the only parameters independently associated with mortality.

Measurement of gas transfer provides additional prognostic information compared to spirometry in patients under hospital follow-up and could be considered routinely.

Abstract

Transfer factor not GOLD stage is the most powerful predictor of survival in patients with COPD http://ow.ly/mGmjG

Footnotes

  • This article has supplementary material available from www.erj.ersjournals.com

  • Support statement: The study was supported by NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK.

  • Conflict of interest: None declared.

  • This article was modified in April 2016 to correct errors in the licence information.

  • Received September 14, 2012.
  • Accepted January 6, 2013.
  • ©ERS 2013

ERJ Open articles are open access and distributed under the terms of the (Creative Commons Attribution Non-Commercial Licence 3.0)

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European Respiratory Journal: 42 (3)
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Lung function indices for predicting mortality in COPD
Afroditi K. Boutou, Dinesh Shrikrishna, Rebecca J. Tanner, Cayley Smith, Julia L. Kelly, Simon P. Ward, Michael I. Polkey, Nicholas S. Hopkinson
European Respiratory Journal Sep 2013, 42 (3) 616-625; DOI: 10.1183/09031936.00146012

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Lung function indices for predicting mortality in COPD
Afroditi K. Boutou, Dinesh Shrikrishna, Rebecca J. Tanner, Cayley Smith, Julia L. Kelly, Simon P. Ward, Michael I. Polkey, Nicholas S. Hopkinson
European Respiratory Journal Sep 2013, 42 (3) 616-625; DOI: 10.1183/09031936.00146012
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