Predictors for P<sub>a</sub>O<sub>2</sub>and Hypoxemic Respiratory Failure in COPD–A Three-Year Follow-up

Saure, EW; Eagan, Tomas Mikal; Jensen, Robert L.; Bakke, Per; Johannessen, Ane; Aanerud, Marianne; Nilsen, Roy Miodini; Thorsen, Einar; Hardie, Jon A.

doi:10.3109/15412555.2014.898027

Cited by 11 publications

(13 citation statements)

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“…Finally, oxygen saturations were only measured on two occasions, limiting further conclusions about disease trajectory and raising the question about variability. When Saure and colleagues measured PaO 2 at multiple intervals over a 3-year period, they found highly conserved values [28], suggesting that our method and findings are valid.…”

Section: Discussionmentioning

confidence: 76%

“…Despite these differences in study outcomes, Vold et al identified male sex, FEV 1 ≤ 50% predicted, ≥10 pack-years smoking history, BMI ≥30 kg/m 2 , and C-reactive protein ≥5 mg/L as independent predictors of an oxygen saturation decline of ≥2%. In another 3-year study of 419 participants with GOLD 2 to 4 stage COPD, Saure and colleagues found no significant change in P a O 2 over time, but 15% of the normoxic participants developed at least one episode of hypoxemia [28]. They did not identify any variables predictive of change in P a O 2 .…”

Section: Discussionmentioning

confidence: 99%

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Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study

et al. 2016

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BackgroundHypoxemia is a major complication of COPD and is a strong predictor of mortality. We previously identified independent risk factors for the presence of resting hypoxemia in the COPDGene cohort. However, little is known about characteristics that predict onset of resting hypoxemia in patients who are normoxic at baseline. We hypothesized that a combination of clinical, physiologic, and radiographic characteristics would predict development of resting hypoxemia after 5-years of follow-up in participants with moderate to severe COPDMethodsWe analyzed 678 participants with moderate-to-severe COPD recruited into the COPDGene cohort who completed baseline and 5-year follow-up visits and who were normoxic by pulse oximetry at baseline. Development of resting hypoxemia was defined as an oxygen saturation ≤88% on ambient air at rest during follow-up. Demographic and clinical characteristics, lung function, and radiographic indices were analyzed with logistic regression models to identify predictors of the development of hypoxemia.ResultsForty-six participants (7%) developed resting hypoxemia at follow-up. Enrollment at Denver (OR 8.30, 95%CI 3.05–22.6), lower baseline oxygen saturation (OR 0.70, 95%CI 0.58–0.85), self-reported heart failure (OR 6.92, 95%CI 1.56–30.6), pulmonary artery (PA) enlargement on computed tomography (OR 2.81, 95%CI 1.17–6.74), and prior severe COPD exacerbation (OR 3.31, 95%CI 1.38–7.90) were independently associated with development of resting hypoxemia. Participants who developed hypoxemia had greater decline in 6-min walk distance and greater 5-year decline in quality of life compared to those who remained normoxic at follow-up.ConclusionsDevelopment of clinically significant hypoxemia over a 5-year span is associated with comorbid heart failure, PA enlargement and severe COPD exacerbation. Further studies are needed to determine if treatments targeting these factors can prevent new onset hypoxemia.Trial registrationCOPDGene is registered at ClinicalTrials.gov: NCT00608764 (Registration Date: January 28, 2008)Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0331-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study

et al. 2016

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“…Among patients without HRF at baseline, risk factors of having developed HRF at follow-up were analyzed using multivariable logistic regression. Factors to be evaluated in the main model were selected based on subject matter knowledge9–11 and included sex, age, BMI, FEV 1 , number of exacerbations in the previous year, CAT score, heart disease, and obstructive sleep apnea syndrome. The predictive ability of the model was assessed as the area under the receiver operator characteristic curve (AUC).…”

Section: Methodsmentioning

confidence: 99%

“…In addition, lower total lung capacity, lower functional residual capacity, higher resting heart rate, and lower fat mass index were associated with hypoxemia, although not with changes in arterial tension of oxygen (PaO 2 ) over time 11. Subsequently, knowledge on the epidemiology and risk factors of developing HRF, especially for patients in clinical practice, is limited.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for developing hypoxic respiratory failure in COPD

Sundh¹,

Ekström²

2017

COPD

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BackgroundHypoxemia is associated with worse outcomes in COPD. The aim of the study was to investigate the prevalence, incidence, and risk factors of hypoxic respiratory failure (HRF) in COPD.Patients and methodsThis was a longitudinal analysis of data from the Swedish National Register of COPD. HRF was defined as resting saturation ≤88% or long-term oxygen therapy. Risk factors for developing HRF were analyzed using multiple logistic regression and receiver operating characteristic curve analysis.ResultsA total of 3,061 patients were included; mean forced expiratory volume in 1 second was 1.47 L; mean age was 70 years; and 54% were females. Median follow-up time was 1.8 years (interquartile range 1.3–2.4 years). HRF was present in 43 (1.4%) patients at baseline and 74 (2.4%) patients at follow-up. Among patients without HRF at baseline, 49 (1.6%) developed HRF during follow-up. The risk was highest for patients in Global initiative for Chronic Obstructive Lung Disease (GOLD) 2017 stage IV or groups C or D at baseline. Developing HRF was independently predicted by lower forced expiratory volume in 1 second and lower COPD Assessment Test score, with a c-statistic of 0.84 (95% CI, 0.70–0.91). When the multivariable model used the GOLD 2017 variables stages I–IV and the dichotomized variables frequent exacerbations and COPD Assessment Test ≥10; the c-statistic increased slightly to 0.86 (95% CI, 0.80–0.92; P<0.0001).ConclusionIn patients with COPD, the prevalence and incidence of HRF was low and was predicted well by more severe air flow limitation and worse health status. The risk is highest in patients with GOLD stage IV and GOLD groups C or D.

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“…As ventilation/perfusion (·V/·Q) mismatch resulting from airway obstruction, destruction of the pulmonary capillary bed and parenchymal destruction (emphysema) is the potential mechanism underlying the development of CRF in COPD, we hypothesized that physiological indices, such as forced expiratory volume in 1 s (FEV 1 ) and diffusing capacity, are closely associated with oxygenation and the future development of CRF. However, few studies have conducted sequential arterial blood gas (ABG) analysis, including partial arterial pressure of oxygen (PaO 2 ) assessments in patients with COPD, and the available data are inconsistent . Saure et al .…”

Section: Introductionmentioning

confidence: 99%

Annual decline in arterial blood oxygen predicts development of chronic respiratory failure in COPD with mild hypoxaemia: A 6‐year follow‐up study

et al. 2018

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Predictors for P_aO₂and Hypoxemic Respiratory Failure in COPD–A Three-Year Follow-up

Abstract: This longitudinal study identified pulmonary, cardiac and metabolic risk factors for overall PaO2 and episodic hypoxemia, but detected no change in PaO2 over time.

Cited by 11 publications

References 24 publications

Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study

Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study

Risk factors for developing hypoxic respiratory failure in COPD

Annual decline in arterial blood oxygen predicts development of chronic respiratory failure in COPD with mild hypoxaemia: A 6‐year follow‐up study

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Predictors for PaO2and Hypoxemic Respiratory Failure in COPD–A Three-Year Follow-up

Abstract: This longitudinal study identified pulmonary, cardiac and metabolic risk factors for overall PaO2 and episodic hypoxemia, but detected no change in PaO2 over time.

Cited by 11 publications

References 24 publications

Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study

Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study

Risk factors for developing hypoxic respiratory failure in COPD

Annual decline in arterial blood oxygen predicts development of chronic respiratory failure in COPD with mild hypoxaemia: A 6‐year follow‐up study

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Predictors for P_aO₂and Hypoxemic Respiratory Failure in COPD–A Three-Year Follow-up