Toru Oga1, Hiroyuki Taniguchi2, Hideo Kita3, Tomomasa Tsuboi4, Keisuke Tomii5, Morihide Ando6, Eiji Kojima7, Hiromi Tomioka8, Yoshio Taguchi9, Yusuke Kaji9, Ryoji Maekura10, Toru Hiraga10, Naoki Sakai11, Tomoki Kimura2, Michiaki Mishima12, Kazuo Chin1. 1. Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 2. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan. 3. Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Osaka, Japan. 4. Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Kyoto, Japan. 5. Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan. 6. Department of Pulmonary Medicine, Ogaki Municipal Hospital, Gifu, Japan. 7. Department of Respiratory Medicine, Komaki City Hospital, Aichi, Japan. 8. Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Hyogo, Japan. 9. Department of Respiratory Medicine, Tenri Hospital, Nara, Japan. 10. Department of Respiratory Medicine, National Hospital Organization Toneyama Hospital, Osaka, Japan. 11. Department of Respiratory Medicine, Otsu Red Cross Hospital, Shiga, Japan. 12. Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: Health status and mortality are important outcomes in patients with advanced pulmonary diseases receiving noninvasive ventilation (NIV). However, their relationship has not been thoroughly investigated. METHODS: The present study prospectively recruited 56 stable outpatients treated with NIV for chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease and/or pulmonary tuberculosis sequelae. At baseline, health status was measured by the Medical Outcomes Study 36-item short form, a generic questionnaire; the St. George's Respiratory Questionnaire (SGRQ), a respiratory-specific questionnaire; and two respiratory failure-specific questionnaires, the Maugeri Respiratory Failure questionnaire and the Severe Respiratory Insufficiency (SRI) questionnaire. Arterial blood gas, pulmonary function, dyspnea and psychological status were also measured. RESULTS: In cross-sectional comparisons of the four health status questionnaires, the SGRQ and SRI questionnaire had lower floor and ceiling effects. During the 3-year follow-up, 16 patients (29%) died. Health status shown by the SGRQ and SRI was significantly predictive of mortality, independently of the physiological measures of low body mass index (BMI), hypercapnia, and low pulmonary function. Stepwise multivariate analyses indicated that the SRI summary score was the most significant predictor of mortality (P = 0.0006) followed by BMI (P = 0.012). CONCLUSION: There was a significant relationship between health status and 3-year mortality in patients with NIV, independently of under-nutrition, hypercapnia and low pulmonary function. Health status measurement is important not only to comprehensively evaluate disease severity in relation to its close association with mortality, but also to elucidate factors that improve the survival of patients with advanced respiratory diseases.
BACKGROUND: Health status and mortality are important outcomes in patients with advanced pulmonary diseases receiving noninvasive ventilation (NIV). However, their relationship has not been thoroughly investigated. METHODS: The present study prospectively recruited 56 stable outpatients treated with NIV for chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease and/or pulmonary tuberculosis sequelae. At baseline, health status was measured by the Medical Outcomes Study 36-item short form, a generic questionnaire; the St. George's Respiratory Questionnaire (SGRQ), a respiratory-specific questionnaire; and two respiratory failure-specific questionnaires, the Maugeri Respiratory Failure questionnaire and the Severe Respiratory Insufficiency (SRI) questionnaire. Arterial blood gas, pulmonary function, dyspnea and psychological status were also measured. RESULTS: In cross-sectional comparisons of the four health status questionnaires, the SGRQ and SRI questionnaire had lower floor and ceiling effects. During the 3-year follow-up, 16 patients (29%) died. Health status shown by the SGRQ and SRI was significantly predictive of mortality, independently of the physiological measures of low body mass index (BMI), hypercapnia, and low pulmonary function. Stepwise multivariate analyses indicated that the SRI summary score was the most significant predictor of mortality (P = 0.0006) followed by BMI (P = 0.012). CONCLUSION: There was a significant relationship between health status and 3-year mortality in patients with NIV, independently of under-nutrition, hypercapnia and low pulmonary function. Health status measurement is important not only to comprehensively evaluate disease severity in relation to its close association with mortality, but also to elucidate factors that improve the survival of patients with advanced respiratory diseases.
Authors: Tim Raveling; Gerrie Bladder; Judith M Vonk; Jellie A Nieuwenhuis; Fransien M Verdonk-Struik; Peter J Wijkstra; Marieke L Duiverman Journal: Int J Chron Obstruct Pulmon Dis Date: 2018-11-01