Predictors of mortality in patients with emphysema and severe airflow obstruction

Fernando J. Martinez*, Gregory Foster, Jeffrey L. Curtis, Gerard Criner, Gail Weinmann, Alfred Fishman, Malcolm M. DeCamp, Joshua Benditt, Frank Sciurba, Barry Make, Zab Mohsenifar, Philip Diaz, Eric Hoffman, Robert Wise

*Corresponding author for this work

Research output: Contribution to journalArticle

312 Citations (Scopus)

Abstract

Purpose: Limited data exist describing risk factors for mortality in patients having predominantly emphysema. Subjects and Methods: Atotal of 609 patients with severe emphysema (ages 40-83 yr; 64.2% male) randomized to the medical therapy arm of the National Emphysema Treatment Trial formed the study group. Cox proportional hazards regression analysis was used to investigate risk factors for all-cause mortality. Risk factors examined included demographics, body mass index, physiologic data, quality of life, dyspnea, oxygen utilization, hemoglobin, smoking history, quantitative emphysema markers on computed tomography, and a modification of a recently described multifunctional index (modified BODE). Results: Overall, high mortality was seen in this cohort (12.7 deaths per 100 person-years; 292 total deaths). In multivariate analyses, increasing age (p = 0.001), oxygen utilization (p = 0.04), lower total lung capacity % predicted (p = 0.05), higher residual volume % predicted (p = 0.04), lower maximal cardiopulmonary exercise testing workload (p = 0.002), greater proportion of emphysema in the lower lung zone versus the upper lung zone (p = 0.005), and lower upper-to-lower-lung perfusion ratio (p = 0.007), and modified BODE (p = 0.02) were predictive of mortality. FEV1 was a significant predictor of mortality in univariate analysis (p = 0.005), but not in multivariate analysis (p = 0.21). Conclusion: Although patients with advanced emphysema experience significant mortality, subgroups based on age, oxygen utilization, physiologic measures, exercise capacity, and emphysema distribution identify those at increased risk of death.

Original languageEnglish (US)
Pages (from-to)1326-1334
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume173
Issue number12
DOIs
StatePublished - Jun 15 2006

Fingerprint

Emphysema
Mortality
Oxygen
Lung
Multivariate Analysis
Exercise
Total Lung Capacity
Residual Volume
Workload
Dyspnea
Hemoglobins
Body Mass Index
Perfusion
Smoking
History
Tomography
Regression Analysis
Quality of Life
Demography
Therapeutics

Keywords

  • Chronic obstructive pulmonary disease
  • Computed tomography
  • Mortality
  • Prognosis
  • Pulmonary function

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Martinez, F. J., Foster, G., Curtis, J. L., Criner, G., Weinmann, G., Fishman, A., ... Wise, R. (2006). Predictors of mortality in patients with emphysema and severe airflow obstruction. American journal of respiratory and critical care medicine, 173(12), 1326-1334. https://doi.org/10.1164/rccm.200510-1677OC
Martinez, Fernando J. ; Foster, Gregory ; Curtis, Jeffrey L. ; Criner, Gerard ; Weinmann, Gail ; Fishman, Alfred ; DeCamp, Malcolm M. ; Benditt, Joshua ; Sciurba, Frank ; Make, Barry ; Mohsenifar, Zab ; Diaz, Philip ; Hoffman, Eric ; Wise, Robert. / Predictors of mortality in patients with emphysema and severe airflow obstruction. In: American journal of respiratory and critical care medicine. 2006 ; Vol. 173, No. 12. pp. 1326-1334.
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abstract = "Purpose: Limited data exist describing risk factors for mortality in patients having predominantly emphysema. Subjects and Methods: Atotal of 609 patients with severe emphysema (ages 40-83 yr; 64.2{\%} male) randomized to the medical therapy arm of the National Emphysema Treatment Trial formed the study group. Cox proportional hazards regression analysis was used to investigate risk factors for all-cause mortality. Risk factors examined included demographics, body mass index, physiologic data, quality of life, dyspnea, oxygen utilization, hemoglobin, smoking history, quantitative emphysema markers on computed tomography, and a modification of a recently described multifunctional index (modified BODE). Results: Overall, high mortality was seen in this cohort (12.7 deaths per 100 person-years; 292 total deaths). In multivariate analyses, increasing age (p = 0.001), oxygen utilization (p = 0.04), lower total lung capacity {\%} predicted (p = 0.05), higher residual volume {\%} predicted (p = 0.04), lower maximal cardiopulmonary exercise testing workload (p = 0.002), greater proportion of emphysema in the lower lung zone versus the upper lung zone (p = 0.005), and lower upper-to-lower-lung perfusion ratio (p = 0.007), and modified BODE (p = 0.02) were predictive of mortality. FEV1 was a significant predictor of mortality in univariate analysis (p = 0.005), but not in multivariate analysis (p = 0.21). Conclusion: Although patients with advanced emphysema experience significant mortality, subgroups based on age, oxygen utilization, physiologic measures, exercise capacity, and emphysema distribution identify those at increased risk of death.",
keywords = "Chronic obstructive pulmonary disease, Computed tomography, Mortality, Prognosis, Pulmonary function",
author = "Martinez, {Fernando J.} and Gregory Foster and Curtis, {Jeffrey L.} and Gerard Criner and Gail Weinmann and Alfred Fishman and DeCamp, {Malcolm M.} and Joshua Benditt and Frank Sciurba and Barry Make and Zab Mohsenifar and Philip Diaz and Eric Hoffman and Robert Wise",
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Martinez, FJ, Foster, G, Curtis, JL, Criner, G, Weinmann, G, Fishman, A, DeCamp, MM, Benditt, J, Sciurba, F, Make, B, Mohsenifar, Z, Diaz, P, Hoffman, E & Wise, R 2006, 'Predictors of mortality in patients with emphysema and severe airflow obstruction', American journal of respiratory and critical care medicine, vol. 173, no. 12, pp. 1326-1334. https://doi.org/10.1164/rccm.200510-1677OC

Predictors of mortality in patients with emphysema and severe airflow obstruction. / Martinez, Fernando J.; Foster, Gregory; Curtis, Jeffrey L.; Criner, Gerard; Weinmann, Gail; Fishman, Alfred; DeCamp, Malcolm M.; Benditt, Joshua; Sciurba, Frank; Make, Barry; Mohsenifar, Zab; Diaz, Philip; Hoffman, Eric; Wise, Robert.

In: American journal of respiratory and critical care medicine, Vol. 173, No. 12, 15.06.2006, p. 1326-1334.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors of mortality in patients with emphysema and severe airflow obstruction

AU - Martinez, Fernando J.

AU - Foster, Gregory

AU - Curtis, Jeffrey L.

AU - Criner, Gerard

AU - Weinmann, Gail

AU - Fishman, Alfred

AU - DeCamp, Malcolm M.

AU - Benditt, Joshua

AU - Sciurba, Frank

AU - Make, Barry

AU - Mohsenifar, Zab

AU - Diaz, Philip

AU - Hoffman, Eric

AU - Wise, Robert

PY - 2006/6/15

Y1 - 2006/6/15

N2 - Purpose: Limited data exist describing risk factors for mortality in patients having predominantly emphysema. Subjects and Methods: Atotal of 609 patients with severe emphysema (ages 40-83 yr; 64.2% male) randomized to the medical therapy arm of the National Emphysema Treatment Trial formed the study group. Cox proportional hazards regression analysis was used to investigate risk factors for all-cause mortality. Risk factors examined included demographics, body mass index, physiologic data, quality of life, dyspnea, oxygen utilization, hemoglobin, smoking history, quantitative emphysema markers on computed tomography, and a modification of a recently described multifunctional index (modified BODE). Results: Overall, high mortality was seen in this cohort (12.7 deaths per 100 person-years; 292 total deaths). In multivariate analyses, increasing age (p = 0.001), oxygen utilization (p = 0.04), lower total lung capacity % predicted (p = 0.05), higher residual volume % predicted (p = 0.04), lower maximal cardiopulmonary exercise testing workload (p = 0.002), greater proportion of emphysema in the lower lung zone versus the upper lung zone (p = 0.005), and lower upper-to-lower-lung perfusion ratio (p = 0.007), and modified BODE (p = 0.02) were predictive of mortality. FEV1 was a significant predictor of mortality in univariate analysis (p = 0.005), but not in multivariate analysis (p = 0.21). Conclusion: Although patients with advanced emphysema experience significant mortality, subgroups based on age, oxygen utilization, physiologic measures, exercise capacity, and emphysema distribution identify those at increased risk of death.

AB - Purpose: Limited data exist describing risk factors for mortality in patients having predominantly emphysema. Subjects and Methods: Atotal of 609 patients with severe emphysema (ages 40-83 yr; 64.2% male) randomized to the medical therapy arm of the National Emphysema Treatment Trial formed the study group. Cox proportional hazards regression analysis was used to investigate risk factors for all-cause mortality. Risk factors examined included demographics, body mass index, physiologic data, quality of life, dyspnea, oxygen utilization, hemoglobin, smoking history, quantitative emphysema markers on computed tomography, and a modification of a recently described multifunctional index (modified BODE). Results: Overall, high mortality was seen in this cohort (12.7 deaths per 100 person-years; 292 total deaths). In multivariate analyses, increasing age (p = 0.001), oxygen utilization (p = 0.04), lower total lung capacity % predicted (p = 0.05), higher residual volume % predicted (p = 0.04), lower maximal cardiopulmonary exercise testing workload (p = 0.002), greater proportion of emphysema in the lower lung zone versus the upper lung zone (p = 0.005), and lower upper-to-lower-lung perfusion ratio (p = 0.007), and modified BODE (p = 0.02) were predictive of mortality. FEV1 was a significant predictor of mortality in univariate analysis (p = 0.005), but not in multivariate analysis (p = 0.21). Conclusion: Although patients with advanced emphysema experience significant mortality, subgroups based on age, oxygen utilization, physiologic measures, exercise capacity, and emphysema distribution identify those at increased risk of death.

KW - Chronic obstructive pulmonary disease

KW - Computed tomography

KW - Mortality

KW - Prognosis

KW - Pulmonary function

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U2 - 10.1164/rccm.200510-1677OC

DO - 10.1164/rccm.200510-1677OC

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