Health-related quality of life and long-term prognosis in chronic hypercapnic respiratory failure: a prospective survival analysis
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vor 17 Jahren
Background: Health-related quality of life (HRQL) is considered as
an important outcome parameter in patients with chronic diseases.
This study aimed to assess the role of disease-specific HRQL for
long-term survival in patients of different diagnoses with chronic
hypercapnic respiratory failure (CHRF). Methods: In a cohort of 231
stable patients (chronic obstructive pulmonary disease (COPD), n =
98; non-COPD (obesity-hypoventilation syndrome, restrictive
disorders, neuromuscular disorders), n = 133) with CHRF and current
home mechanical ventilation (HMV), HRQL was assessed by the
disease-specific Severe Respiratory Insufficiency (SRI)
questionnaire and its prognostic value was prospectively evaluated
during a follow-up of 2-4 years, using univariate and multivariate
regression analysis. Results: HRQL was more impaired in COPD (mean
+/- SD SRI-summary score (SRI-SS) 52.5 +/- 15.6) than non-COPD
patients (67.6 +/- 16.4; p < 0.001). Overall mortality during
28.9 +/- 8.8 months of follow-up was 19.1% (31.6% in COPD, 9.8% in
non-COPD). To identify the overall role of SRI, we first evaluated
the total study population. SRI-SS and its subdomains (except
attendance symptoms and sleep), as well as body mass index (BMI),
leukocyte number and spirometric indices were associated with
long-term survival (p < 0.01 each). Of these, SRI-SS, leukocytes
and forced expiratory volume in I s (FEV(I)) turned out to be
independent predictors (p < 0.05 each). More specifically, in
non-COPD patients SRI-SS and most of its subdomains, as well as
leukocyte number, were related to survival (p < 0.05), whereas
in patients with COPD only BMI and lung function but not SRI were
predictive. Conclusion: In patients with CHRF and HMV, the
disease-specific SRI was an overall predictor of long-term survival
in addition to established risk factors. However, the SRI
predominantly beared information regarding long-term survival in
non-COPD patients, while in COPD patients objective measures of the
disease state were superior. This on one hand highlights the
significance of HRQL in the long-term course of patients with CHRF,
on the other hand it suggests that the predictive value of HRQL
depends on the underlying disease.
an important outcome parameter in patients with chronic diseases.
This study aimed to assess the role of disease-specific HRQL for
long-term survival in patients of different diagnoses with chronic
hypercapnic respiratory failure (CHRF). Methods: In a cohort of 231
stable patients (chronic obstructive pulmonary disease (COPD), n =
98; non-COPD (obesity-hypoventilation syndrome, restrictive
disorders, neuromuscular disorders), n = 133) with CHRF and current
home mechanical ventilation (HMV), HRQL was assessed by the
disease-specific Severe Respiratory Insufficiency (SRI)
questionnaire and its prognostic value was prospectively evaluated
during a follow-up of 2-4 years, using univariate and multivariate
regression analysis. Results: HRQL was more impaired in COPD (mean
+/- SD SRI-summary score (SRI-SS) 52.5 +/- 15.6) than non-COPD
patients (67.6 +/- 16.4; p < 0.001). Overall mortality during
28.9 +/- 8.8 months of follow-up was 19.1% (31.6% in COPD, 9.8% in
non-COPD). To identify the overall role of SRI, we first evaluated
the total study population. SRI-SS and its subdomains (except
attendance symptoms and sleep), as well as body mass index (BMI),
leukocyte number and spirometric indices were associated with
long-term survival (p < 0.01 each). Of these, SRI-SS, leukocytes
and forced expiratory volume in I s (FEV(I)) turned out to be
independent predictors (p < 0.05 each). More specifically, in
non-COPD patients SRI-SS and most of its subdomains, as well as
leukocyte number, were related to survival (p < 0.05), whereas
in patients with COPD only BMI and lung function but not SRI were
predictive. Conclusion: In patients with CHRF and HMV, the
disease-specific SRI was an overall predictor of long-term survival
in addition to established risk factors. However, the SRI
predominantly beared information regarding long-term survival in
non-COPD patients, while in COPD patients objective measures of the
disease state were superior. This on one hand highlights the
significance of HRQL in the long-term course of patients with CHRF,
on the other hand it suggests that the predictive value of HRQL
depends on the underlying disease.
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