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Wells JM, Estepar RSJ, McDonald MLN, Bhatt SP, Diaz AA, Bailey WC, Jacobson FL, Dransfield MT, Washko GR, Make BJ, Casaburi R, van Beek EJR, Hoffman EA, Sciurba FC, Crapo JD, Silverman EK, Hersh CP. Clinical, physiologic, and radiographic factors contributing to development of hypoxemia in moderate to severe COPD: a cohort study. BMC Pulm Med 2016; 16:169. [PMID: 27903260 PMCID: PMC5131397 DOI: 10.1186/s12890-016-0331-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background Hypoxemia is a major complication of COPD and is a strong predictor of mortality. We previously identified independent risk factors for the presence of resting hypoxemia in the COPDGene cohort. However, little is known about characteristics that predict onset of resting hypoxemia in patients who are normoxic at baseline. We hypothesized that a combination of clinical, physiologic, and radiographic characteristics would predict development of resting hypoxemia after 5-years of follow-up in participants with moderate to severe COPD Methods We analyzed 678 participants with moderate-to-severe COPD recruited into the COPDGene cohort who completed baseline and 5-year follow-up visits and who were normoxic by pulse oximetry at baseline. Development of resting hypoxemia was defined as an oxygen saturation ≤88% on ambient air at rest during follow-up. Demographic and clinical characteristics, lung function, and radiographic indices were analyzed with logistic regression models to identify predictors of the development of hypoxemia. Results Forty-six participants (7%) developed resting hypoxemia at follow-up. Enrollment at Denver (OR 8.30, 95%CI 3.05–22.6), lower baseline oxygen saturation (OR 0.70, 95%CI 0.58–0.85), self-reported heart failure (OR 6.92, 95%CI 1.56–30.6), pulmonary artery (PA) enlargement on computed tomography (OR 2.81, 95%CI 1.17–6.74), and prior severe COPD exacerbation (OR 3.31, 95%CI 1.38–7.90) were independently associated with development of resting hypoxemia. Participants who developed hypoxemia had greater decline in 6-min walk distance and greater 5-year decline in quality of life compared to those who remained normoxic at follow-up. Conclusions Development of clinically significant hypoxemia over a 5-year span is associated with comorbid heart failure, PA enlargement and severe COPD exacerbation. Further studies are needed to determine if treatments targeting these factors can prevent new onset hypoxemia. Trial registration COPDGene is registered at ClinicalTrials.gov: NCT00608764 (Registration Date: January 28, 2008) Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0331-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL, USA. .,Lung Health Center University of Alabama Birmingham, Birmingham, AL, USA. .,Birmingham VA Medical Center, Birmingham, AL, USA. .,, 1900 University Blvd, THT 422, Birmingham, AL, 35294, USA.
| | | | - Merry-Lynn N McDonald
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL, USA.,Lung Health Center University of Alabama Birmingham, Birmingham, AL, USA
| | - Alejandro A Diaz
- Division of Pulmonary Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - William C Bailey
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL, USA.,Lung Health Center University of Alabama Birmingham, Birmingham, AL, USA
| | | | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL, USA.,Lung Health Center University of Alabama Birmingham, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - George R Washko
- Division of Pulmonary Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Barry J Make
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Edwin J R van Beek
- Department of Radiology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James D Crapo
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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