FVC/DLCO identifies pulmonary hypertension and predicts 5-year all-cause mortality in patients with COPD

Abstract

Background Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD). However, it is unknown whether the ratio of forced vital capacity (FVC) to diffusing lung capacity for carbon monoxide (DLCO) can identify PH in the patients with COPD and predict its prognosis. Methods The study population I included 937 COPD patients who were admitted to inpatient treatments from 2010 to 2017, and finally 750 patients were available to follow-up the 5-year all-cause mortality (study population II). Clinical characteristics of the study population were recorded. Results COPD patients with PH had a higher FVC/DLCO value compared with the patients without PH. The threshold for FVC/DLCO to identify PH in COPD patients was 0.44 l/mmol/min/kPa. Multivariate logistic regression analysis showed that FVC/DLCO was a significant predictor for PH in the patients with COPD. The study population II showed that the 5-year all-cause mortality of COPD patients was significantly higher in combined with PH group than without PH group. Compared with the survivor group, FVC/DLCO value was significantly increased in non-survivor group. The threshold for FVC/DLCO to predict 5-year all-cause mortality was 0.41 l/mmol/min/kPa. Kaplan–Meier survival curves showed that 5-year cumulative survival rate for COPD patients were significantly decreased when the value of FVC/DLCO was ≥ 0.41 l/mmol/min/kPa. Multivariate cox regression analysis showed that FVC/DLCO was an independent prognostic factor for 5-year all-cause mortality in COPD patients. Conclusion FVC/DLCO could identify PH in the patients with COPD and was an independent predictor for 5-year all-cause mortality of COPD.

Predictors of Mortality in Pulmonary Hypertension-Associated Chronic Lung Disease

“…Surprisingly, we did not find that a severely reduced DLCO, defined as <40% predicted, to be associated with mortality, despite the literature that supports this parameter in both chronic lung disease and pulmonary hypertension [ 16 , 35 , 36 ]. There are several potential reasons as to why we did not find a similar significance.…”

Prediction of clinical risk assessment and survival in chronic obstructive pulmonary disease with pulmonary hypertension

“…The development of online risk assessment nomogram software will provide a clinical tool for long‐term management of patients with COPD and COPD–PH in primary hospitals or community centres. In addition, in contrast to previous single‐centre studies, 18 , 23 , 24 our study included a larger sample of patients with COPD–PH, and used a multicentre study design and internal and external validation. These processes contributed to improving the reliability and generalisability of our research findings.…”

“…These processes contributed to improving the reliability and generalisability of our research findings. Unlike previous studies, 18 , 23 , 24 this study adheres to the latest diagnostic criteria from the European Society of Cardiology guidelines. Moreover, we used RHC to show PH in patients with COPD, which is more accurate than other studies that used Doppler echocardiography to diagnose PH.…”

“…Moreover, we used RHC to show PH in patients with COPD, which is more accurate than other studies that used Doppler echocardiography to diagnose PH. 23 , 24 Our risk assessment nomogram may have clinical implications for individualised follow‐up and guidance of therapeutic strategy in patients. Optimisation of such software will lessen the requirement for the clinician's subjective impression or time‐consuming manual measurements.…”