Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD

de-Torres, J.P. ; O'Donnell, D.E. ; Marín, J.M. (Universidad de Zaragoza) ; Cabrera, C. ; Casanova, C. ; Marín, M. ; Ezponda, A. ; Cosio, B.G. ; Martinez, C. ; Solanes I. ; Fuster A. ; Neder J.A. ; Gonzalez-Gutierrez, J. ; Celli, B.R.

Resumen: Background: The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (DLCO) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low DLCO has not been explored. Research Question: Could a DLCO threshold help define an increased risk of death and a different clinical presentation in these patients? Study Design and Methods: GOLD stage I COPD patients (n = 360) were enrolled and followed over 109 ± 50 months. Age, sex, pack-years’ history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for DLCO was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality. Results: A DLCO cutoff value of <60% predicted was associated with all-cause mortality (DLCO = 60%: 9% vs DLCO < 60%: 23%, P = .01). At a same FEV1% predicted and Charlson score, patients with DLCO < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a DLCO < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) Interpretation: In GOLD I COPD patients, a DLCO < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined. © 2021 American College of Chest Physicians

Idioma: Inglés

DOI: 10.1016/j.chest.2021.04.033

Año: 2021

Publicado en: Chest 160, 3 (2021), 872-878
ISSN: 0012-3692

Factor impacto JCR: 11.393 (2021)

Categ. JCR: CRITICAL CARE MEDICINE rank: 5 / 35 = 0.143 (2021) - Q1 - T1
Categ. JCR: RESPIRATORY SYSTEM rank: 6 / 66 = 0.091 (2021) - Q1 - T1

Factor impacto CITESCORE: 10.0 - Medicine (Q1)

Factor impacto SCIMAGO: 2.264 - Critical Care and Intensive Care Medicine (Q1) - Cardiology and Cardiovascular Medicine (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)