Is hypercapnia associated with poor prognosis in chronic obstructive pulmonary disease? A long-term follow-up cohort study

Yang, Hui; Xiang, Ping; Zhang, Erming; Guo, Wei; Shi, Yanwei; Zhang, Shuo; Tong, Zhaohui

doi:10.1136/bmjopen-2015-008909

Cited by 51 publications

(41 citation statements)

References 31 publications

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“…Ju et al 18 observed that cor pulmonale patients had lower FEV1 and FEV1/FVC. Unlike our findings, Yang et al 19 observed that cor pulmonale was significantly higher in hypercapnic as compared to normocapnic patients. Verbitskii et al 20 reported insignificant hypoxemia in cor pulmonale, which progressed with decompensation of chronic cor pulmonale.…”

contrasting

confidence: 56%

The relationship between acidosis and hypercapnia with Cor pulmonale in patients with chronic obstructive pulmonary disease

Hosseininia¹,

Aliasgharzadeh²,

Zamani³

et al. 2017

J Anal Res Clin Med

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SpirometryCor pulmonale or right ventricular (RV) enlargement is cardiovascular complication of the chronic obstructive pulmonary disease (COPD). Hypoxic pulmonary vasoconstriction, hypercapnia, acidosis and pulmonary vascular remodeling are suggested as possible mechanisms of cor pulmonale. In this study, we aimed to evaluate the correlation between acidosis and hypercapnia with corpulmonale in patients with COPD.In this cross-sectional analytical study, 100 patients (56 men and 44 women with mean age of 66.53 ± 10.63 years) with moderate to severe COPD exacerbation were included. Complete history taking and physical examination as well as atrial blood gas, pulmonary function test (PFT) and echocardiography were performed. Disease severity was defined according to global initiative for obstructive lung disease (GOLD), Modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) criteria. Patients with cor pulmonale were defined and findings were compared between patients with and without cor pulmonale.Forty-two patients had cor pulmonale. There was no significant difference in hypercapnia between groups. Cor pulmonale patients, compared to non-cor pulmonale, had significantly lower forced expiratory volume in the first second (FEV1) (P = 0.020), higher tricuspid regurgitation (TR) (P = 0.001) and pulmonary hypertension (P = 0.020). There was significantly negative correlation between RV thickness with FEV1/forced vital capacity (FCV) (r = -0.239, P = 0.010) and RV size with FEV1/FVC (r = -0.312, P = 0.002) and positive correlation with partial pressure of carbon dioxide (PaCO2) (r = 0.312, P = 0.002) and bicarbonate (HCO3) (r = 0.258, P = 0.009).Cor pulmonale in the course of COPD accompanies with adverse outcome. These patients have worse spirometry and left ventricle echocardiographic findings, but have no difference in arterial blood gas (ABG) findings.Citation: Hosseininia S, Aliasgharzadeh-Khiavi S, Zamani B, Habibzadeh A, Kheirjo S, Sadeghieh-Ahari S. The relationship between acidosis and hypercapnia with Cor pulmonale in patients with chronic obstructive pulmonary disease.

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contrasting

confidence: 56%

The relationship between acidosis and hypercapnia with Cor pulmonale in patients with chronic obstructive pulmonary disease

Hosseininia¹,

Aliasgharzadeh²,

Zamani³

et al. 2017

J Anal Res Clin Med

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“… 5 Previous studies have shown conflicting results regarding the influence of chronic hypercapnia on prognosis. 12 , 13 If hypercapnia is associated with bad prognosis, it would be more logical that by decreasing daytime PaCO 2 , survival would be positively influenced. In the present study, we did not find this, even not in a separate analysis of those patients with severe hypercapnia before NIV initiation.…”

Section: Discussionmentioning

confidence: 99%

Improvement in hypercapnia does not predict survival in COPD patients on chronic noninvasive ventilation

Raveling¹,

Bladder²,

Vonk³

et al. 2018

COPD

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PurposeIt has recently been shown that chronic noninvasive ventilation (NIV) improves a number of outcomes including survival, in patients with stable hypercapnic COPD. However, the mechanisms responsible for these improved outcomes are still unknown. The aim of the present study was to identify parameters associated with: 1) an improved arterial partial pressure of carbon dioxide (PaCO2) and 2) survival, in a cohort of hypercapnic COPD patients treated with chronic NIV.Patients and methodsData from 240 COPD patients treated with chronic NIV were analyzed. Predictors for the change in PaCO2 and survival were investigated using multivariate linear and Cox regression models, respectively.ResultsA higher level of bicarbonate before NIV initiation, the use of higher inspiratory ventilator pressures, the presence of anxiety symptoms, and NIV initiated following an exacerbation compared to NIV initiated in stable disease were associated with a larger reduction in PaCO2. A higher body mass index, a higher FEV1, a lower bicarbonate before NIV initiation, and younger age and NIV initiation in stable condition were independently associated with better survival. The change in PaCO2 was not associated with survival, neither in a subgroup of patients with a PaCO2 >7.0 kPa before the initiation of NIV.ConclusionPatients with anxiety symptoms and a high bicarbonate level at NIV initiation are potentially good responders in terms of an improvement in hypercapnia. Also, higher inspiratory ventilator pressures are associated with a larger reduction in PaCO2. However, the improvement in hypercapnia does not seem to be associated with an improved survival and emphasizes the need to look beyond PaCO2 when considering NIV initiation.

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“…Several studies have shown that chronic hypercapnia was an important symbol of poor prognosis in COPD patients. 28 , 29 Long-term survival analysis showed that mortality would increase by 30%–40% in 2 years if patients have both chronic respiratory failure and hypercapnia. 30 According to a long-term observation on stable COPD patients carried out by Leger et al, 31 stable COPD patients with long-term survival had a significantly lower PaCO 2 than the early death.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of long-term noninvasive positive pressure ventilation in stable hypercapnic COPD patients with respiratory failure: a meta-analysis of randomized controlled trials

Liao

Pei

et al. 2017

COPD

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IntroductionThe efficacy of long-term noninvasive positive pressure ventilation (NPPV) in stable hypercapnic COPD patients with respiratory failure remains unclear. The aim of this meta-analysis was to critically assess the efficacy of long-term NPPV on mortality, acute exacerbation, exercise capacity, symptoms and significant physiological parameters (lung function, respiratory muscle function and gas exchange).Patients and methodsWe performed an electronic literature search using the PubMed, Cochrane Library, Embase, OVID and Chinese Biomedical Literature Database in May 2017. Studies comparing treatment effects of NPPV with oxygen therapy in stable hypercapnic COPD patients with respiratory failure were conducted, and at least one of the following parameters were reviewed: frequency of acute exacerbation, mortality, lung function, respiratory muscle function, gas exchange, exercise capacity.ResultsSeven studies with 810 subjects were identified. The partial pressure of arterial carbon dioxide (PaCO2) significantly decreased in patients who received long-term NPPV (weighted mean difference [WMD] −3.73, 95% CI: −5.83 to −1.64, P=0.0005). No significant difference was found in mortality, partial pressure of arterial oxygen (PaO2), frequency of acute exacerbation, lung function, respiratory muscle function and exercise capacity. The subgroup analysis showed that NPPV significantly improved the survival of patients when it was targeted at greatly reducing hypercapnia (WMD 0.35, 95% CI: 0.19 to 0.64, P=0.0006).ConclusionThe results indicate that long-term NPPV decreases the PaCO2 of stable hypercapnic COPD patients with respiratory failure and improves mortality with the aim of reducing PaCO2.

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Is hypercapnia associated with poor prognosis in chronic obstructive pulmonary disease? A long-term follow-up cohort study

Cited by 51 publications

References 31 publications

The relationship between acidosis and hypercapnia with Cor pulmonale in patients with chronic obstructive pulmonary disease

The relationship between acidosis and hypercapnia with Cor pulmonale in patients with chronic obstructive pulmonary disease

Improvement in hypercapnia does not predict survival in COPD patients on chronic noninvasive ventilation

Efficacy of long-term noninvasive positive pressure ventilation in stable hypercapnic COPD patients with respiratory failure: a meta-analysis of randomized controlled trials

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