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Published ahead of print on March 16, 2006, doi:10.1164/rccm.200510-1677OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 12, June 2006, 1326-1334

A more recent version of this article appeared on June 15, 2006
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Submitted on October 27, 2005
Accepted on March 16, 2006

Predictors of Mortality in Patients with Emphysema and Severe Airflow Obstruction

Fernando J Martinez1*, Gregory Foster2, Jeffrey L Curtis1, Gerard Criner3, Gail Weinmann4, Alfred Fishman5, Malcolm M DeCamp6, Joshua Benditt7, Frank Sciurba8, Barry Make9, Zab Mohsenifar10, Philip Diaz11, Eric Hoffman12, and Robert Wise2

1 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA, 2 Department of Epidemiology and Department of Medicine, Johns Hopkins University, Baltimore, MD, USA, 3 Pulmonary and Critical Care Medicine, Temple University, Philadelphia, PA, USA, 4 Division of Lung Diseases, National Heart, Lung and Blood Institute, Bethesda, MD, USA, 5 Division of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA, 6 Section of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA, 7 Department of Medicine, University of Washington, Seattle, WA, USA, 8 Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA, 9 Division of Pulmonary Sciences, National Jewish Medical and Research Center, Denver, CO, USA, 10 Division of Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA, 11 Department of Internal Medicine, Ohio State University, Columbus, OH, USA, 12 Department of Radiology, University of Iowa, Iowa City, IA, USA

* To whom correspondence should be addressed. E-mail: fmartine{at}med.umich.edu.

Purpose: Limited data exist describing risk factors for mortality in patients having predominately emphysema. Subjects and Methods: Six hundred and nine severe emphysema patients (age 40-83 years; 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 demographic information, physiologic data, quality of life, dyspnea, oxygen utilization, hemoglobin, smoking history, quantitative emphysema markers on CT, and a 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 TLC % predicted (P=0.05), higher RV % predicted (P=0.04), lower maximal CPET workload (P=0.002) and greater proportion of emphysema in the lower lung zone vs the upper (P=0.005), and lower upper to lower lung perfusion ratio (P=0.007) were predictive of mortality. Used in place of its components a higher modified BODE index predicted mortality (P=0.02). FEV1was a significant predictor of mortality on 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, emphysema, prognosis, pulmonary function




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