Factores relacionados con la supervivencia en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica grave a largo plazo: relación con la capacidad aeróbica Supervivencia y capacidad aeróbica en pacientes con EPOC
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Introducción: Sólo Oga et al. (AJRCCM 2003) relacionaron supervivencia y capacidad aeróbica en pacientes EPOC, pero en hombres y seguimiento a 5 años.
Objetivos: Evaluar la supervivencia de una cohorte de pacientes EPOC grave según el consumo de oxígeno pico (VO2p) ajustado al peso.
Materiales y Métodos: Se evaluó la supervivencia a largo plazo desde el diagnóstico de pacientes con EPOC (GOLD). Se midió el VO2p ajustado por peso en prueba cicloergométrica máxima (gases espirados). Se usaron técnicas estadísticas convencionales y análisis de supervivencia de LogRank (Mantel-Cox).
Resultados: 70 pacientes (27% femenino); edad 68 años (RIQ 63-73); %FEV1 postBD: 39,95±2,09; VO2p: 9,25± 3,17 ml/kg/min. GOLD D/B/A 84,3/14,2/1,5%; GOLD II/III/IV: 15,7/61,4/22,9%. A 14 años de seguimiento, 75% habían fallecido. Supervivencia: primer cuartilo de VO2p (ml/kg/min) fue 38,5 meses (RIQ 18,25-58,5) y para el cuarto cuartilo 68 meses (RIQ 48-93). A 103 meses, la diferencia en supervivencia fue: primer cuartilo vs. cuarto cuartilo de VO2p (p<0,01) y segundo vs. cuarto cuartilo (p<0,03); a 145 meses entre segundo vs. cuarto cuartilo (p=0,049). En análisis multivariado, el VO2p alto es factor protector sobre la mortalidad. En cambio, otras variables independientes como sexo masculino, edad>70, grado de obstrucción bronquial severo y fenotipo exacerbador frecuente se asociaron a mortalidad.
Conclusión: A largo plazo, en una cohorte de pacientes hombres y mujeres EPOC grave, en análisis multivariado, el VO2p alto es factor protector sobre la mortalidad. En cambio, otras variables independientes como sexo masculino, edad>70, grado de obstrucción bronquial severo y exacerbador frecuente se asociaron a mortalidad.
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Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of COPD 2023. [Internet]. [Consultado 1 mar 2024]. Disponible en: https://goldcopd.org/2023-gold-report-2/
GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015 : a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 2017; 5:691. Doi: 10.1016/S2213-2600(17)30293-X
Echazarreta A, Arias S, del Olmo R et al. Prevalencia de EPOC en 6 aglomerados urbanos de Argentina: el estudio EPOC.AR. Arch Bronconeumol 2018;54:260-9. Doi: 10.1016/j.arbres.2017.09.018
Arias S, Echazarreta A. Epidemiología de la EPOC. En: Abordaje del paciente con EPOC. AAMR, 2024. [Internet]. [Consultado 11 jul 2024]. Disponible en: https://www.aamr.org.ar/secciones/inmunologia_enf_obstructivas/24_03_06_libro_epoc_aamr_tl.pdf
Scanlon PD, Connett JE, Waller LA et al. Smoking Cessation and lung function in moderate COPD: The Lung Health Study. Am J Respir Crit Care Med 2000;161:381-90. Doi: 10.1164/ajrccm.161.2.9901044.
Nocturnal Oxygen Therapy Trial Group. Continuous or Nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease. Ann Int Med 1980;93;391-8. Doi: 10.7326/0003-4819-93-3-391.
Medical Research Council Working Party. Long-term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1981;1:681-6. Doi: 10.1016/S0140-6736(81)91970-X
Celli BR. Monitoring the progression of chronic obstructive pulmonary disease: time for new staging system. Eur Respir Rev 1999;9:165–8.
Gerardi DA, Lovett L, Bennoti-Connors ML, Reardon JZ, Zu Wallack R. Variables related to increased mortality following out-patient pulmonary rehabilitation. Eur Respir J 1996;9:431–435. Doi: 10.1183/09031936.96.09030431.
Pinto-Plata VM, Cote C, Cabral H, Taylor J, Celli BR. The 6-min walk distance: change over time and value as a predictor of survival in severe COPD. Eur Respir J 2004;23:28–33. Doi: 10.1183/09031936.03.00034603.
Schols AMWJ, Slangen J, Volovics L, Wouters EFM. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1791–1797. Doi: 10.1164/ajrccm.157.6.9705017.
Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;160:1856–1861. Doi: 10.1164/ajrccm.160.6.9902115.
Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 2002;121:1434–1440. Doi: 10.1378/chest.121.5.1434.
Casanova C, Cote C, de Torres JP et al. Inspiratory to total lung capacity ratio predicts mortality in patients with COPD. Am J Respir Crit Care Med 2005;171:591-7. Doi: 10.1164/rccm.200407-867OC.
Soler Cataluña JJ, Martinez Garcia MA, Sanchez RP, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in COPD. Thorax 2005;60:925-31. Doi: 10.1136/thx.2005.040527
Sivori M, Fernández R, Toibaro J, Velasquez Gortaire E. Supervivencia en una cohorte de pacientes con EPOC acorde a la clasificación GOLD 2017. Medicina Buenos Aires 2019:79:20-28.
Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32:962-969. Doi: 10.1183/09031936.00012408.
Lange P, Nyboe J, Appleyard M, Jensen G, Schnohr P. Relation of ventilator impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes. Thorax 1990;45:579-85. Doi: 10.1136/thx.45.8.579.
Fan VS, Curtis JR, Tu SP, McDonell MB, Fihn SD. Using quality of life to predict hospitalization and mortality in patients with obstructive lung diseases. Chest 2002;122:429-36. Doi: 10.1378/chest.122.2.429.
Dicker AJ, Huang JTJ, Lonergan M et al. The sputum microbiome airway inflammation and mortality in COPD. J Allergy Clin Immunol 2020;147:158-67. Doi: 10.1016/j.jaci.2020.02.040
Mehrotra N, Freire AX, Bauer DC et al. Predictors of mortality in elderly subjects with obstructive airway disease: the PILE score. Ann Epidemiol 2010;20:223-32. Doi: 10.1016/j.annepidem.2009.11.005.
Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factor related to mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2003;167:544–49. Doi: 10.1164/rccm.200206-583OC.
Miller M, Hankinson J, Brusasco V et al. ATS-ERS Task Force: Standartisation of spirometry. Eur Respir J 2005; 26:319-38. Doi: 10.1183/09031936.05.00034805.
American Thoracic Society. ATS Statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-7. Doi: 10.1164/ajrccm.166.1.at1102.
Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999;159:179-87. Doi: 10.1164/ajrccm.159.1.9712108.
Borg G. Psychophysical basis of perceived exertion. Med Sci Sports Exer 1982; 14:377-81.
American Thoracic Society, American College of Chest Physicians ATS/ACCP. Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003; 167:211-77. Doi: 10.1164/rccm.167.2.211.
Carter R, Nicrota B, Blevins W, Holiday D. Altered exercise gas exchange and cardiac function in patients with mild chronic obstructive pulmonary disease. Chest 1993; 103: 745–50. Doi: 10.1378/chest.103.3.745.
Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. Am Rev Respir Dis 1992;145;1321-7. Doi: 10.1164/ajrccm/145.6.1321.
Celli BR, Cote C, Marin JM et al. The Body Mass Index, Airflow Obstruction, Dyspnea, Exercise Performance (BODE) Index in chronic obstructive pulmonary disease. N Engl J Med 2004;350:1005–12. Doi: 10.1056/NEJMoa021322.
Charlson ME, Pompei P, Ales KL et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. Doi: 10.1016/0021-9681(87)90171-8.
Charlson M, Szatrowski TP, Peterson J et al. Validation of a combined comorbidity index. J Clin Epidemiol 1994; 47:1245-51. Doi: 10.1016/0895-4356(94)90129-5.
Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: an update. Can J Appl Physiol 2004;29:90–115. Doi: 10.1139/h04-008.
Garcia Aymerich J, Lange P, Benet M, Schnohr P, Antó J. Regular physical activity reduces hospital admission and mortality in COPD: a population based cohort study. Thorax 2002;61:772-8. Doi: 10.1136/thx.2006.060145.
Blair SN, Kohl HW 3rd, Barlow CE, Paffenbarger RS Jr, Gibbons LW, Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 1995;273:1093–8.
Blair SN, Kampert JB, Kohl 3rd HW et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 199;276: 205–10.
Ohrt WM, Malley MT, Coogan AR et al. Effects of gender, age and fitness level on response of VO2max to training in 60 –71 yr olds. J Appl Physiol 1985;71: 2004 –11. Doi: 10.1152/jappl.1991.71.5.2004.
Kokkinos P, Myers J, Faselis C et al. Exercise capacity and mortality in older men: a 20-year follow-up study. Circulation 2010;122:790 –7. Doi: 10.1161/CIRCULATIONAHA.110.938852.
Lee DC, Sui X, Ortega FB et al. Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. Br J Sports Med 2011;45:504-10. Doi:10.1136/bjsm.2009.066209.
Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U. S. Department of Health and Human Services. Nutr Rev 2009;67:114-20. Doi: 10.1111/j.1753-4887.2008.00136.x.
United States Department of Health and Human Services. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Surgeon General´s Report on Physical Activity and Health. JAMA 1996;276:522. Doi:10.1001/jama.1996.03540070018010.
Wasfy MM, Baggish AL. Exercise Dose in clinical practice. Circulation 2016;133:2297-313. Doi: 10.1161/CIRCULATIONAHA.116.018093.
Cote CG, Pinto Plata VM, Marin JM, Nekach H, Dordelly lJ, Celli BR. The modified BODE index validation and mortality in COPD. Eur Respir J 2008;32:1269-74. Doi: 10.1183/09031936.00138507.
Levine BD. VO2max: what do we know, and what do we still need to know? J Physiol 2008;586:25–34. Doi: 10.1113/jphysiol.2007.147629.
Boushel R, Gnaiger E, Calbet JAL et al. Muscle mitochondrial capacity exceeds maximal oxygen delivery in humans. Mitochondrion 2011;11:303–7. Doi: 10.1016/j.mito.2010.12.006.
Gustafson MP, DiCostanzo AC, Wheatley CM et al. A systems biology approach to investigating the influence of exercise and fitness on the composition of leukocytes in peripheral blood. J Immunother Cancer 2017;5:30. Doi: 10.1186/s40425-017-0231-8
Duggal NA, Pollock RD, Lazarus NR et al. Major features of immunesenescence, including reduced thymic output, are ameliorated by high levels of physical activity in adulthood. Aging Cell 2018;17:e12750. Doi: 10.1111/acel.12750.
Bartlett DB, Duggal NA. Moderate physical activity associated with a higher naïve/memory T-cell ratio in healthy old individuals: potential role of IL15. Age Ageing 2020;49:368–73. Doi: 10.1093/ageing/afaa035.
Spielmann G, McFarlin BK, O'Connor DP et al. Aerobic fitness is associated with lower proportions of senescent blood T-cells in man. Brain Behav Immun 2011;25:1521–9. Doi: 10.1016/j.bbi.2011.07.226.
Sivori M, Capparelli I, Gonzalez C et al. Recomendaciones en rehabilitación respiratoria 2018. Rev Am Med Respir 2019;3:211-32.
Sivori M, Rhodius E, Kaplan P et al. Entrenamiento muscular en la EPOC: estudio comparativo del entrenamiento aeróbico de miembros inferiores vs. combinación con miembros superiores. Medicina Buenos Aires 1998; 58:717-27.
Figueroa Casas JC, Schiavi E, Mazzei JA et al. Recomendaciones para la prevención, diagnóstico y tratamiento de la EPOC en la Argentina. Medicina Buenos Aires 2012; 72 (Supl I):1-33.
Putcha N, Anzueto AR, Calverley PMA et al. Mortality and exacerbations risk by body mass index in patients CODP in TIOSPIR and UPLIFT. Ann Am Thorac Sc 2022;19:204-13. Doi: 10.1513/AnnalsATS.202006-722OC.
Celli B, Vestbo J, Jenkins CR et al. Sex differences in mortality and clinical expressions of patients with COPD: The TORCH Experience. Am J Respir Crit Care Med 2011;183:317-22. Doi: 10.1164/rccm.201004-0665OC.
Pellegrino R, Viegi G, Brusasco V et al. ATS/ERS Tas Force: Standardisation of Lung Function Testing: Interpretative strategies for lung function tests. Eur Respir J 2005,26:948-68. Doi: 10.1183/09031936.05.00035205.