scholarly journals Efficacy of Remdesivir-Containing Therapy in Hospitalized COVID-19 Patients: A Prospective Clinical Experience

2021 ◽  
Vol 10 (17) ◽  
pp. 3784
Author(s):  
Alessandro Russo ◽  
Erica Binetti ◽  
Cristian Borrazzo ◽  
Elio Gentilini Cacciola ◽  
Luigi Battistini ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Real Life ◽  
Study Groups ◽  
Cox Regression Analysis ◽  
High Flow Oxygen ◽  
The Impact

Objectives: Remdesivir is currently approved for the treatment of COVID-19. The recommendation for using remdesivir in patients with COVID-19 was based on the in vitro and in vivo activity of this drug against SARS-CoV-2. Methods: This was a prospective observational study conducted on a population of patients hospitalized for COVID-19. The primary endpoint of this study was the impact of remdesivir-containing therapy on 30-day mortality; the secondary endpoint was the impact of remdesivir-containing therapy on the need for high-flow oxygen therapy (HFNC), non-invasive ventilation (NIV), or mechanical ventilation. The data were analyzed after propensity score matching. Results: A total of 407 patients with SARS-CoV-2 pneumonia were consecutively enrolled. Out of these, 294 (72.2%) were treated with remdesivir and 113 (27.8%) were not. Overall, 61 patients (14.9%) were treated during hospitalization with HFNC, NIV, or mechanical ventilation, while 30-day mortality was observed in 21 patients (5.2%). Univariate analysis of patients treated with remdesivir or not showed no differences in 30-day mortality (4% vs. 6%, p = 0.411) in the two study groups. Cox regression analysis, after propensity score matching, showed that therapies, including remdesivir-containing therapy, were not statistically associated with 30-day survival or mortality. The Kaplan–Meier curves of 30-day survival in patients treated with remdesivir or not before (p = 0.24) and after (p = 0.88) propensity score matching showed no differences between the two study groups. Finally, patients treated with remdesivir or not showed the same need for HFNC/NIV or mechanical ventilation. Conclusions: This real-life experience of remdesivir use in hospitalized patients with COVID-19 was not associated with significant increases in rates of survival or reduced use of HFNC/NIV or mechanical ventilation compared with patients treated with other therapies not including remdesivir.

scholarly journals Efficacy of remdesivir-containing therapy in hospitalized COVID-19 patients: a prospective clinical experience

2021 ◽  
Author(s):  
Alessandro Russo ◽  
Erica Binetti ◽  
Cristian Borrazzo ◽  
Elio Gentilini Cacciola ◽  
Luigi Battistini ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Large Population ◽  
Real Life ◽  
Cox Regression Analysis ◽  
Non Invasive ◽  
High Flow Oxygen ◽  
The Impact

Objectives: remdesivir is currently approved for the treatment of COVID-19. The recommendation for using remdesivir in COVID-19 was based on the in vitro and in vivo activity of this drug against SARS-CoV-2. Methods: this was a prospective, observational study conducted on a large population of patients hospitalized for COVID-19. The primary endpoint of the study was to evaluate the impact of remdesivir-containing therapy on 30-day mortality; secondary endpoint was the impact of remdesivir-containing therapy on the need of high flow oxygen therapy (HFNC) or non-invasive ventilation (NIV) or mechanical ventilation. Data were analyzed after propensity score matching. Results: 407 patients with SARS-CoV-2 pneumonia were consecutively enrolled. Out of these, 294 (72.2%) and 113 (27.8%) were respectively treated or not with remdesivir. Overall, 61 (14.9%) patients were treated during hospitalization with non-invasive or mechanical ventilation, while a 30-day mortality was observed in 21 (5.2%) patients. Cox regression analysis, after propensity score matching, showed that therapies, including remdesivir-containing therapy, were not statistically associated with 30-day survival or mortality, while need of HFNC/NIV (HR 17.921, CI95% 0.954-336.73, p=0.044) and mechanical ventilation (HR 3.9, CI95% 5.36-16.2, p=0.003) resulted independently associated with 30-day mortality. Finally, therapies including or not remdesivir were not independently associated with lower or higher risk of HFNC/NIV or mechanical ventilation. Conclusions: this real-life experience about the remdesivir use in hospitalized patients with COVID-19 was not associated with significant increase in rates of survival or reduced use of HFNC/NIV or mechanical ventilation, compared to patients treated with other therapies not including remdesivir.

scholarly journals Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: A propensity score matching analysis

2020 ◽  
Author(s):  
Chih-Wen Lin ◽  
Yaw-Sen Chen ◽  
Gin-Ho Lo ◽  
Yao-Chun Hsu ◽  
Chia-Chang Hsu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Resection ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Tace Group ◽  
The Impact

Abstract Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). However, TACE in combination with radiofrequency ablation (RFA) is not inferior to surgical resection (SR), and the benefits of surgical resection (SR) for BCLC stage B HCC remain unclear. Hence, this study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC. Methods: Overall, 428 HCC patients were included in BCLC stage B, and their clinical data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Results: One hundred forty (32.7%) patients received SR, 231 (53.9%) received TACE+RFA, and 57 (13.3%) received TACE. The OS was significantly higher in the SR group than that in the TACE+RFA group [hazard ratio (HR): 1.78; 95% confidence incidence (CI): 1.15-2.75, p=0.009]. The OS was significantly higher in the SR group than that in the TACE group (HR: 3.17; 95% CI: 2.31-4.36, p<0.0001). Moreover, the OS was significantly higher in the TACE+RFA group than that in the TACE group (HR: 1.82; 95% CI: 1.21-2.74, p=0.004). The cumulative OS rates at 1, 3 and 5 years in the SR, TACE+RFA, and TACE groups were 89.2%, 69.4% and 61.2%, 86.0%, 57.9% and 38.2%, and 69.5%, 37.0% and 15.2%, respectively. After propensity score matching, the SR group still had a higher OS than those of the TACE+RFA and TACE groups. The TACE+RFA group had a higher OS than that of the TACE group. Conclusion: The SR group had higher OS than the TACE+RFA and TACE groups in BCLC stage B HCC. Furthermore, the TACE+RFA group had higher OS than the TACE group.

scholarly journals Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: A propensity score matching analysis

2020 ◽  
Author(s):  
Chih-Wen Lin ◽  
Yaw-Sen Chen ◽  
Gin-Ho Lo ◽  
Yao-Chun Hsu ◽  
Chia-Chang Hsu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Resection ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Tace Group ◽  
The Impact

Abstract Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). However, TACE in combination with radiofrequency ablation (RFA) is not inferior to surgical resection (SR), and the benefits of surgical resection (SR) for BCLC stage B HCC remain unclear. Hence, this study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC.Methods: Overall, 428 HCC patients were included in BCLC stage B, and their clinical data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Results: One hundred forty (32.7%) patients received SR, 231 (53.9%) received TACE+RFA, and 57 (13.3%) received TACE. The OS was significantly higher in the SR group than that in the TACE+RFA group [hazard ratio (HR): 1.78; 95% confidence incidence (CI): 1.15-2.75, p=0.009]. The OS was significantly higher in the SR group than that in the TACE group (HR: 3.17; 95% CI: 2.31-4.36, p<0.0001). Moreover, the OS was significantly higher in the TACE+RFA group than that in the TACE group (HR: 1.82; 95% CI: 1.21-2.74, p=0.004). The cumulative OS rates at 1, 3 and 5 years in the SR, TACE+RFA, and TACE groups were 89.2%, 69.4% and 61.2%, 86.0%, 57.9% and 38.2%, and 69.5%, 37.0% and 15.2%, respectively. After propensity score matching, the SR group still had a higher OS than those of the TACE+RFA and TACE groups. The TACE+RFA group had a higher OS than that of the TACE group. Conclusion: The SR group had higher OS than the TACE+RFA and TACE groups in BCLC stage B HCC. Furthermore, the TACE+RFA group had higher OS than the TACE group.

With versus Without Primary Tumor Radiotherapy in Patients with Unresectable Stage IV Rectal or Rectosigmoid Cancer: A Propensity Score Matching Analysis for Survival

2020 ◽  
Author(s):  
Gang Wang ◽  
Ling Wen Wang ◽  
Jie Hai Jin ◽  
min Hong Dong ◽  
wei Wei Chen ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Primary Tumor ◽  
Cox Regression ◽  
Stage Iv ◽  
Rectosigmoid Cancer ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
The Impact

Abstract Background: To evaluate the impact of primary tumor radiotherapy on survival in patients with unresectable metastatic rectal or rectosigmoid cancer. Methods: Form September 2008 to September 2017, 350 patients with unresectable metastatic rectal or rectosigmoid cancer were retrospectively reviewed in our center. All patients received at least 4 cycles of chemotherapy, and were divided into two groups according to with primary tumor radiotherapy or without. 163 patients received primary tumor radiotherapy, and the median radiation dose was 56.69Gy(50.4-60). Survival curves were estimated from the Kaplan–Meier procedure to roughly compare survival among two groups. Subsequently, 18-month survival was used as the outcome variable for this study. This study mainly evaluated the impact of primary tumor radiotherapy on survival of these patients through a series of multivariate Cox regression analyses after propensity score matching (PSM). Results: The median follow-up time was 21 months. All 350 patients received a median of 7 cycles of chemotherapy (range 4-12), 163 (46.67%) patients received primary tumor radiotherapy for local symptoms. The Kaplan–Meier survival curves showed a significant overall survival (OS) advantage for primary tumor radiotherapy group to without radiotherapy (20.07 vs 17.33 months; P=0.002). In this study, multivariate Cox regression analysis after adjusted covariates, multivariate Cox regression analysis after PSM, and inverse probability of treatment weighting (IPTW) analysis and propensity score (PS)-adjusted model analysis consistently showed that primary tumor radiotherapy could effectively reduce the risk of death for these patients at 18 months (HR: 0.62, 95% CI 0.40-0.98; HR:0.79, 95% CI:0.93-1.45; HR: 0.70, 95% CI 0.55-0.99 and HR: 0.74, 95% CI:0.59-0.94). Conclusion: Compared with patients with stage IV rectal or rectosigmoid cancer who did not receive primary tumor radiotherapy, received primary tumor radiotherapy reduced the risk of death in these patients. The radical doses（59.4Gy/ 33 fractions or 60Gy/ 30 fractions） of radiation for primary tumors might be considered for unresectable metastatic rectal or rectosigmoid cancer, not just for relieve symptoms. Keywords: Stage IV Rectal cancer, primary tumor radiotherapy, propensity score matching.

scholarly journals The impact of thrombocytopenia on prognosis of HBV-related small hepatocellular carcinoma: a propensity score matching analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wei Peng ◽  
Chuan Li ◽  
Xiaoyun Zhang ◽  
Tianfu Wen ◽  
Zheyu Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Outcome ◽  
Cox Regression ◽  
Small Hepatocellular Carcinoma ◽  
Cox Regression Analysis ◽  
Small Hcc ◽  
The Impact

Abstract Background Thrombocytopenia was reported both detrimental and advantageous to hepatocellular carcinoma (HCC). However, there is little evidence showing clearly the clinical value of preoperative thrombocytopenia on the surgical outcome of patients with small HCC. This retrospective study aimed at elucidating the correlation between preoperative thrombocytopenia and surgical outcome of small HCC patients within Milan criteria treated with liver resection. Methods Data of hepatitis B virus (HBV)-related small HCC patients were retrospectively analyzed, and we performed the propensity score matching (PSM) analysis to overcome the imbalance of clinicopathological features. Patients enrolled were subsequently categorized into two groups according to preoperative platelet counts: thrombocytopenia group and non-thrombocytopenia group. Survival outcomes of the patients in both groups were described with the Kaplan-Meier method, and the difference was compared with a log-rank test. Cox regression analysis was applied to identify the risk factors of surgical outcome. Results After PSM, the estimated 1-, 3-, and 5-year overall survival (OS) rates for small HCC patients in the thrombocytopenia group were 94.5%, 77.0%, and 57.6%, and 95.0%, 79.6%, and 68.0%, respectively, for small HCC patients in the non-thrombocytopenia group (P = 0.042). And the 1-, 3-, and 5-year estimated recurrence-free survival (RFS) rates for small HCC patients in the thrombocytopenia group were 70.4%, 51.0%, and 42.1%, and 83.8%, 63.7%, and 46.7%, respectively, for small HCC patients in the non-thrombocytopenia group (P = 0.035). Multivariate analysis indicated preoperative thrombocytopenia was a significant prognosticator of poor RFS (hazard ratio (HR) = 1.388, 95% confidence interval (CI) 1.028~1.874, P = 0.033). Conclusion Preoperative thrombocytopenia had an undesirable impact on the recurrence of small HCC patients treated with liver resection.

scholarly journals Surgical Resection Significantly Promotes the Overall Survival of Patients with Hepatocellular Carcinoma: A Propensity Score Matching Analysis

2021 ◽  
Author(s):  
Pei-Min Hsieh ◽  
Hung-Yu Lin ◽  
Chao-Ming Hung ◽  
Gin-Ho Lo ◽  
I-Cheng Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Resection ◽  
Cox Regression ◽  
Survival Rates ◽  
Hbv Infection ◽  
Cox Regression Analysis

Abstract Background: The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages.Methods: Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed.Results: In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0-96) months for the total cohort and was subdivided into 52 (8-96), 32 (1-96), 19 (0-84), and 12 (0-79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were 1) SR and cirrhosis; 2) SR, cirrhosis, and Child-Pugh (C-P) class; 3) SR, hepatitis B virus (HBV) infection, and C-P class; and 4) SR, HBV infection, and C-P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs non-SR were 44.0% vs 28.7%, 72.2% vs 42.6%, 42.6% vs 36.2, 44.6% vs 23.5%, and 41.4% vs 15.3% (all p-values<0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages.Conclusion: SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.

Effect of statin and metformin on survival in veterans (V) with B-cell lymphoproliferative disorders (BLD).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1602-1602
Author(s):  
Shanthi Srinivas ◽  
Melanie L. Gonzalez ◽  
Sunniya Khan ◽  
Arpita Gandhi ◽  
Barbara Crump ◽  
...  
Keyword(s):  
Rating Scale ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Cox Regression Analysis ◽  
Comorbidity Index ◽  
Beta 2 Microglobulin ◽  
Ecog Ps ◽  
The Impact ◽  
Statin Use

1602 Background: The incidence of BLD has been increasing in V. As many V are on statin and metformin for comorbid conditions, we evaluated the impact of their use on survival. Methods: In an IRB-approved protocol, we reviewed the records of 332 V diagnosed with BLD from January 1997 to Dec 2011 for demographics, height(H),weight(W), BMI,statin and metformin use, clinical and laboratory data and ECOG PS. Comorbidity was assessed using the Charlson Comorbidity Index (CCI),Kaplan-Feinstein Index (KFI) and Cumulative Illness Rating Scale (CIRS). Cox regression analysis was performed using SAS v 9.2. Results: There were 332 V with a median (M) age of 70 years (27-94). The M for H 70 inches (58-78), W 183lbs (99-356.5) and BMI 26.7 kg/m2 (15.54 -48.45). The M for hemoglobin(Hgb) 12.8 g/dl (7.3-17.4), albumin 3.9(1.2-5.4), lactate dehydrogenase( LDH) 183 IU/L (85-1905), beta 2-microglobulin 2.6 mg/dl (0.8-39) . The M for CCI was 4.7 (0.8-12), KFI 2 (0-3), CIRS15 3 (0-6), CIRS16 6(0 -14), CIRS17 1.9(0-6), CIRS18 0(0-3), CIRS19 0(0-3). M survival was 1297days(4-7468).The number of V receiving statin was 167 (51%) and metformin 46 (14%). Statin use was a predictor of survival by both univariate and multivariate analysis but metformin was a predictor only by univariate analysis. Conclusions: Statin use was an independent and significant predictor of survival in this group of V with BLD and needs to be validated in a larger group of patients. [Table: see text]

scholarly journals Temporal Trends in Sepsis Incidence and Mortality in Patients With Cancer in the US Population

2021 ◽  
Vol 30 (4) ◽  
pp. e71-e79
Author(s):  
Michael A. Liu ◽  
Brianna R. Bakow ◽  
Tzu-Chun Hsu ◽  
Jia-Yu Chen ◽  
Ke-Ying Su ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Temporal Trends ◽  
Mortality Rates ◽  
Hazard Ratio ◽  
Patients With Cancer ◽  
Incidence And Mortality ◽  
The Impact

Background Few population-based studies assess the impact of cancer on sepsis incidence and mortality. Objectives To evaluate epidemiological trends of sepsis in patients with cancer. Methods This retrospective cohort study included adults (≥20 years old) identified using sepsis-indicator International Classification of Diseases codes from the Nationwide Inpatient Sample database (2006-2014). A generalized linear model was used to trend incidence and mortality. Outcomes in patients with cancer and patients without cancer were compared using propensity score matching. Cox regression modeling was used to calculate hazard ratios for mortality rates. Results The study included 13 996 374 patients, 13.6% of whom had cancer. Gram-positive infections were most common, but the incidence of gram-negative infections increased at a greater rate. Compared with patients without cancer, those with cancer had significantly higher rates of lower respiratory tract (35.0% vs 31.6%), intra-abdominal (5.5% vs 4.6%), fungal (4.8% vs 2.9%), and anaerobic (1.2% vs 0.9%) infections. Sepsis incidence increased at a higher rate in patients with cancer than in those without cancer, but hospital mortality rates improved equally in both groups. After propensity score matching, hospital mortality was higher in patients with cancer than in those without cancer (hazard ratio, 1.25; 95% CI, 1.24-1.26). Of patients with sepsis and cancer, those with lung cancer had the lowest survival (hazard ratio, 1.65) compared with those with breast cancer, who had the highest survival. Conclusions Cancer patients are at high risk for sepsis and associated mortality. Research is needed to guide sepsis monitoring and prevention in patients with cancer.

scholarly journals Diabetes as a Risk Factor for Cardiovascular Events in Patients Receiving Permanent Pacemaker – A Propensity Score-Matched Cohort Study

2021 ◽  
Author(s):  
Huang-Chung Chen ◽  
Wen-Hao Liu ◽  
Chien-Hao Tseng ◽  
Yung-Lung Chen ◽  
Wei-Chieh Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Study Groups ◽  
Permanent Pacemaker ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Cox Regression Analysis

Abstract Background: Type 2 diabetes was associated with higher risk for permanent pacemaker (PPM) implantation. We aimed to compare the clinical outcomes between diabetic and non-diabetic patients receiving PPM treatment. Methods: Between January 2003 and December 2017, 1742 patients receiving naïve PPM treatment comprised this retrospective cohort study and were categorized into two groups by the presence or absence of diagnosis of diabetes: diabetic group (n=632, 36.3%) and non-diabetic group (n=1110, 63.7%). The primary outcome was cardiovascular events including heart failure (HF) hospitalization and acute myocardial infarction (AMI). Propensity score matching (PSM) was applied to reduce selection bias between the study groups. Results: During a mean follow-up of 7.8 ± 4.8 years, there were 264 cardiovascular events. A total of 746 patients with a 1:1 paired ratio between diabetic and non-diabetic groups were analyzed in the propensity score-matched series. After PSM, the incidence of cardiovascular events was higher in the diabetic group compared to the non-diabetic group (18.8% vs. 12.3%, P=0.015). Moreover, the incidence of HF hospitalization was higher in the diabetic patients compared to the non-diabetic patients (15.3% vs. 10.2%, P=0.037), whereas the incidence of AMI did not differ between the diabetic and non-diabetic groups (3.5% vs. 2.1%, P=0.268). After adjustments for covariates in multiple Cox regression analysis, diabetes remained as an independent predictor for cardiovascular events [hazard ratio, 1.54; 95% confidence interval, 1.04-2.29; P=0.031].Conclusions:In this cohort study of patients with naïve PPMs implantation, diabetes increased 1.54-fold risk of cardiovascular events in PPM recipients, especially for HF hospitalization.

scholarly journals Exertional Desaturation Has Higher Mortality Than Non-Desaturation in COPD

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1110
Author(s):  
Shih-Feng Liu ◽  
Chien-Hung Chin ◽  
Ching-Wang Tseng ◽  
Yung-Che Chen ◽  
Ho-Chang Kuo
Keyword(s):  
Cox Regression ◽  
Univariate Analysis ◽  
Chronic Obstructive ◽  
Maximal Heart Rate ◽  
Obstructive Pulmonary Disease ◽  
Cox Regression Analysis ◽  
Copd Patients ◽  
Average Survival ◽  
Hs Crp ◽  
The Impact

Background and objectives: Exertional desaturation (ED) is often overlooked in chronic obstructive pulmonary disease (COPD). We aim to investigate the impact of ED on mortality and the predictors of ED in COPD. Materials andmethods: A cohort of COPD patients with clinically stable, widely ranging severities were enrolled. ED is defined as oxyhemoglobin saturation by pulse oximetry (SpO2) < 90% or a drop of ΔSpO2 ≥ 4% during a six-minute walk test (6MWT). Cox regression analysis is used to estimate the hazard ratio (HR) for three-year mortality. Results: A total of 113 patients were studied, including ED (N = 34) and non-ED (N = 79) groups. FVC (% of predicted value), FEV1/FVC (%), FEV1 (% of predicted value), DLCO (%), maximal inspiratory pressure, SpO2 during the 6MWT, GOLD stage, and COPD severity were significantly different between the ED and non-ED groups in univariate analysis. Low minimal SpO2 (p < 0.001) and high maximal heart rate (p = 0.04) during the 6MWT were significantly related to ED in multivariate analysis. After adjusting for age, gender, body mass index, 6MWD, FEV1, mMRC, GOLD staging, exacerbation, hs-CRP, and fibrinogen, the mortality rate of the ED group was higher than that of the non-ED group (p = 0.012; HR = 4.12; 95% CI 1.37–12.39). For deaths, the average survival time of ED was shorter than that of the non-ED group (856.4 days vs. 933.8 days, p = 0.033). Conclusions: ED has higher mortality than non-ED in COPD. COPD should be assessed for ED, especially in patients with low minimal SpO2 and high maximal HR during the 6MWT.

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