The 6-Minute-Walk Distance Test as a Chronic Obstructive Pulmonary Disease Stratification Tool. Insights from the COPD Biomarker Qualification Consortium

Celli, Bartolomé R.; Tetzlaff, Kay; Criner, Gerard J.; Polkey, Michael I.; Sciurba, Frank C.; Casaburi, Richard; Tal‐Singer, Ruth; Kawata, Ariane K.; Merrill, Debora; Rennard, Stephen I.

doi:10.1164/rccm.201508-1653oc

Cited by 100 publications

(80 citation statements)

References 51 publications

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“…Different studies have shown how meters walked in the 6MWT predicts mortality in patients with COPD. An analysis performed by Celli et al 30 with more than 14.000 patients, showed that a distance below 350 m predicts mortality in the first 12 months, which is consistent with our results. The patient's functional capacity will not only be influenced by the respiratory component but also with extrapulmonary factors such as comorbidities, peripheral vascular disease or muscle weakness.…”

Section: Discussionsupporting

confidence: 93%

Prognostic ability of the distance‐saturation product in the 6‐minute walk test in patients with chronic obstructive pulmonary disease

Gurbani

Gonçálves

Bello

et al. 2020

Clinical Respiratory J

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Introduction The product (DSP) of the distance walked (meters) and minimum oxygen saturation obtained during the 6‐minute walk test (6MWT) has been proposed as a predictor of mortality in idiopathic pulmonary fibrosis and in bronchiectasis not related to cystic fibrosis. Objective The aim of this study was to determine the DSP's ability to predict mortality in patients with chronic obstructive pulmonary disease (COPD) at the outpatient level and compare it to the BODE index and meters walked in the 6MWT. Material and methods Descriptive observational study in a cohort of patients with COPD being treated at outpatient pulmonology clinics. Each of the patients completed the 6MWT following ATS/ERS protocols and their BODE index and DSP were calculated. Results About 103 patients were included. The average length of follow‐up was 36 months. Patients who died showed a lower number of meters walked in the 6MWT (P < 0.001), as well as a lower DSP (P < 0.001). A 6MWT < 334 m, a DSP < 290 and a BODE ≥ 4 showed good prognostic ability at 3 years (AUC 71%, 69% and 70.4%, respectively). The 6MWT was superior to the BODE index in predicting mortality during the first year of follow‐up (P = 0.023). We did not find any differences between DSP and meters walked in the 6MWT. Conclusions The DSP is a good predictor of mortality, although it does not offer a better prognostic ability than that of meters walked in the 6MWT.

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Section: Discussionsupporting

confidence: 93%

Prognostic ability of the distance‐saturation product in the 6‐minute walk test in patients with chronic obstructive pulmonary disease

Gurbani

Gonçálves

Bello

et al. 2020

Clinical Respiratory J

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“…The choice of these categories was based on the possibility of distinguishing between patients with less impairment and fewer symptoms (6MWD >350 meters and mMRC 0-1 points) and those who are more compromised (6MWD ≤200 meters and mMRC 4 points). The value limits of the three 6MWD categories refer to the greatest, average, or least performance 20 and to the prognostic indication of each in terms of mortality risk, [21][22][23] as previously reported in the literature. Both models were adjusted for age, sex, comorbidities (Charlson index ≥ the median value of 2), severity of airflow obstruction (forced expiratory volume at 1st second -FEV 1 ≤ 50% pred.…”

Section: Discussionmentioning

confidence: 99%

“…Our choice to categorize COPD patients by threshold limits of 6MWD, although perhaps apparently arbitrary, was in fact based on the previous literature [20][21][22][23] and related to the patients' different performance and prognosis. As for the wellknown clinical and prognostic value of the different categories of the mMRC 17 that we also used in this study, we think that the categories here proposed for the 6MWD represent different levels of disability and might play a prognostic role similar to that of mMRC in accurately predicting a meaningful gain post-PR ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%

<p>Baseline Exercise Tolerance and Perceived Dyspnea to Identify the Ideal Candidate to Pulmonary Rehabilitation: A Risk Chart in COPD Patients</p>

Costi¹,

Crisafulli²,

Trianni³

et al. 2019

COPD

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Background: The appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR). Methods: We retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 mins (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes. Results: Compared to the category of individuals with 6MWD >350 meters, those patients with 201-350 meters and ≤200 meters showed a higher probability (p<0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p<0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased. Conclusion: This study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR.

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“…Per GOLD guidelines, a post-bronchodilator FEV 1 /FVC ratio of <0.70 identifies persistent airflow limitation. This differs from ATS guidelines that recommend using ratio less than lower limits of normal (FEV 1 /FVC <LLN) to identify airflow limitation Exercise testing: Walking distance measured by the six-minute walk test or the shuttle walk test is used to assess degree of disability and mortality risk, and to monitor response to pulmonary rehabilitation [22][23][24].…”

Section: Diagnosis Of Copdmentioning

confidence: 98%

Individualized Care in COPD: Updated Guidelines from Revised GOLD 2017 Report

Ratarasarn¹,

Shah²,

Uysal-Biggs³

2017

Chron Obstruct Pulmon Dis

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The 6-Minute-Walk Distance Test as a Chronic Obstructive Pulmonary Disease Stratification Tool. Insights from the COPD Biomarker Qualification Consortium

Abstract: The 6MWD test can be used to stratify patients with COPD for clinical trials and interventions aimed at modifying exacerbations, hospitalizations, or death.

Cited by 100 publications

References 51 publications

Prognostic ability of the distance‐saturation product in the 6‐minute walk test in patients with chronic obstructive pulmonary disease

Prognostic ability of the distance‐saturation product in the 6‐minute walk test in patients with chronic obstructive pulmonary disease

<p>Baseline Exercise Tolerance and Perceived Dyspnea to Identify the Ideal Candidate to Pulmonary Rehabilitation: A Risk Chart in COPD Patients</p>

Individualized Care in COPD: Updated Guidelines from Revised GOLD 2017 Report

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