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 journalArticlepeer-review

369 Scopus citations


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
Issue number12
StatePublished - Jun 15 2006


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

ASJC Scopus subject areas

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


Dive into the research topics of 'Predictors of mortality in patients with emphysema and severe airflow obstruction'. Together they form a unique fingerprint.

Cite this