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Am J Respir Crit Care Med. 2006 Jun 15;173(12):1326-34. Epub 2006 Mar 16.

Predictors of mortality in patients with emphysema and severe airflow obstruction.

Collaborators (448)

Fishman AP, Bozzarello BA, Al-Amin A, Katz M, Wheeler C, Baker E, Barnard P, Cagle P, Carter J, Chatziioannou S, Conejo-Gonzales K, Dubose K, Haddad J, Hicks D, Kleiman N, Milburn-Barnes M, Nguyen C, Reardon M, Reeves-Viets J, Sax S, Sharafkhaneh A, Wilson O, Young C, Espada R, Butanda R, Ellisor M, Fox P, Hale K, Hood E, Jahn A, Jhingran S, King K, Miller C 3rd, Nizami I, Officer T, Ricketts J, Rodarte J, Teague R, Williams K, Reilly J, Sugarbaker D, Fanning C, Body S, Duffy S, Formanek V, Fuhlbrigge A, Hartigan P, Hooper S, Hunsaker A, Jacobson F, Moy M, Peterson S, Russell R, Saunders D, Swanson S, McKenna R, Mohsenifar Z, Geaga C, Biring M, Clark S, Cutler J, Frantz R, Julien P, Lewis M, Minkoff-Rau J, Yegyan V, Joyner M, DeCamp M, Stoller J, Meli Y, Apostolakis J, Atwell D, Chapman J, DeVilliers P, Dweik R, Kraenzler E, Lann R, Kurokawa N, Marlow S, McCarthy K, McCreight P, Mehta A, Meziane M, Minai O, Steiger M, White K, Maurer J, Durr T, Hearn C, Lubell S, O'Donovan P, Schilz R, Ginsburg M, Thomashow B, Jellen P, Austin J, Bartels M, Berkmen Y, Berkoski P, Brogan F, Chong A, DeMercado G, DiMango A, Do S, Kachulis B, Khan A, Mets B, O'Shea M, Pearson G, Rosoff L, Scharf S, Shiau M, Simonelli P, Stavrolakes K, Tsang D, Vilotijevic D, Yip C, Mantinaos M, McKeon K, Pfeffer J, MacIntyre N, Davis RD, Howe J, Coleman RE, Crouch R, Greene D, Grichnik K, Harpole D, Krichman A, Lawlor B, McAdams H, Plankeel J, Rinaldo-Gallo S, Shearer S, Smith J, Stafford-Smith M, Tapson V, Steele M, Norten J, Utz J, Deschamps C, Mieras K, Abel M, Allen M, Andrist D, Aughenbaugh G, Bendel S, Edell E, Edgar M, Edwards B, Elliot B, Garrett J, Gillespie D, Gurney J, Hammel B, Hanson K, Hanson L, Harms G, Hart J, Hartman T, Hyatt R, Jensen E, Jenson N, Kalra S, Karsell P, Lamb J, Midthun D, Mottram C, Swensen S, Sykes AM, Taylor K, Torres N, Hubmayr R, Miller D, Bartling S, Bradt K, Make B, Pomerantz M, Gilmartin M, Canterbury J, Carlos M, Dibbern P, Fernandez E, Geyman L, Hudson C, Lynch D, Newell J, Quaife R, Propst J, Raymond C, Whalen-Price J, Winner K, Zamora M, Cherniack R, Diaz P, Ross P, Bees T, Drake J, Emery C, Gerhardt M, King M, Rittinger D, Rittinger M, Naunheim K, Gerber R, Osterloh J, Borosh S, Chamberlain W, Frese S, Hibbit A, Kleinhenz ME, Ruppel G, Stolar C, Willey J, Alvarez F, Keller C, Criner G, Furukawa S, Kuzma AM, Barnette R, Brister N, Carney K, Chatila W, Cordova F, D'Alonzo G, Keresztury M, Kirsch K, Kwak C, Lautensacek K, Lorenzon M, Martin U, Rising P, Schartel S, Travaline J, Vance G, Boiselle P, O'Brien G, Ries A, Kaplan R, Ramirez C, Frankville D, Friedman P, Harrell J, Johnson J, Kapelanski D, Kupferberg D, Larsen C, Limberg T, Magliocca M, Papatheofanis FJ, Sassi-Dambron D, Weeks M, Krasna M, Fessler H, Moskowitz I, Gilbert T, Orens J, Scharf S, Shade D, Siegelman S, Silver K, Weir C, White C, Martinez F, Iannettoni M, Meldrum C, Bria W, Campbell K, Christensen P, Flaherty K, Gay S, Gill P, Kazanjian P, Kazerooni E, Knieper V, Ojo T, Poole L, Quint L, Rysso P, Sisson T, True M, Woodcock B, Zaremba L, Kaiser L, Hansen-Flaschen J, Dempsey ML, Alavi A, Alcorn T, Arcasoy S, Aronchick J, Aukberg S, Benedict B, Craemer S, Daniele R, Edelman J, Gefter W, Kotler-Klein L, Kotloff R, Lipson D, Miller W Jr, O'Connell R, Opelman S, Palevsky H, Russell W, Sheaffer H, Simcox R, Snedeker S, Stone-Wynne J, Tino G, Wahl P, Walter J, Ward P, Zisman D, Mendez J, Wurster A, Sciurba F, Luketich J, Witt C, Ayres G, Donahoe M, Furhman C, Hoffman R, Lacomis J, Sexton J, Slivka W, Strollo D, Sullivan E, Simon T, Wrona C, Bauldoff G, Brown M, George E, Keenan R, Kopp T, Silfies L, Benditt J, Wood D, Snyder M, Anable K, Battaglia N, Boitano L, Bowdle A, Chan L, Chwalik C, Culver B, Gillespy T, Godwin D, Hoffman J, Ibrahim A, Lockhart D, Marglin S, Martay K, McDowell P, Oxorn D, Roessler L, Toshima M, Golden S, Bosco L, Chiang YP, Clancy C, Handelsman H, Berkowitz SM, Carino T, Chin J, Baldwin J, McVearry K, Norris A, Shirey S, Sikora C, Sheingold S, Piantadosi S, Tonascia J, Belt P, Blackford A, Collins K, Collison B, Colvin R, Dodge J, Donithan M, Edmonds V, Foster GL, Fuller J, Harle J, Jackson R, Lee S, Levine C, Livingston H, Meinert J, Meyers J, Nowakowski D, Owens K, Qi S, Smith M, Simon B, Smith P, Sternberg A, Van Natta M, Wilson L, Wise R, Kaplan RM, Schwartz JS, Chiang YP, Fahs MC, Fendrick AM, Moskowitz AJ, Pathak D, Ramsey S, Sheingold S, Shroyer AL, Wagner J, Yusen R, Ramsey S, Etzioni R, Sullivan S, Wood D, Schroeder T, Kreizenbeck K, Berry K, Howlader N, Hoffman E, Cook-Granroth J, Delsing A, Guo J, McLennan G, Mullan B, Piker C, Reinhardt J, Robinswood B, Sieren J, Stanford W, Waldhausen JA, Bernard G, DeMets D, Ferguson M, Hoover E, Levine R, Mahler D, McSweeny AJ, Wiener-Kronish J, Williams OD, Younes M, Criner G, Soltoff C, Weinmann G, Deshler J, Follmann D, Kiley J, Wu M.

Author information

  • 1Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109-0360, and Section of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA. fmartine@umich.edu

Abstract

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.

Comment in

PMID:
16543549
[PubMed - indexed for MEDLINE]
PMCID:
PMC2662972
Free PMC Article

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