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Published ahead of print on March 16, 2006, doi:10.1164/rccm.200510-1677OC
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American Journal of Respiratory and Critical Care Medicine Vol 173. pp. 1326-1334, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200510-1677OC

Original Article

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 for the NETT Research Group

Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan; Department of Epidemiology and Department of Medicine, Johns Hopkins University, Baltimore; Division of Lung Diseases, National Heart, Lung and Blood Institute, Bethesda, Maryland; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University, Philadelphia; Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh; Division of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Section of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, University of Washington, Seattle, Washington; Division of Pulmonary Sciences, National Jewish Medical and Research Center, Denver, Colorado; Division of Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Department of Internal Medicine, Ohio State University, Columbus, Ohio; and Department of Radiology, University of Iowa, Iowa City, Iowa

Correspondence and requests for reprints should be addressed to Fernando J. Martinez, M.D., M.S., 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109-0360. E-mail: fmartine{at}umich.edu

Purpose: Limited data exist describing risk factors for mortality in patients having predominantly emphysema.

Subjects and Methods: A total 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.

Key Words: chronic obstructive pulmonary disease • computed tomography • mortality • prognosis • pulmonary function




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