Elif ŞEN, Fatma ÇİFTÇİ, Öznur AKKOCA YILDIZ, Sevgi SARYAL

Egzersiz kapasitesi, dispne derecesi veya yaşam kalitesi KOAH hastalarında mortaliteyi yansıtır mı? 8-yıllık izlem

Giriş: Kronik obstrüktif akciğer hastalığı (KOAH)'nda tedavinin amacı dispneyi azaltmak, egzersiz kapasitesini ve yaşam kalitesini arttırmaktır. Egzersiz kapasitesi, dispne düzeyi ve yaşam kalitesi ile uzun dönem mortalite arasındaki ilişki belirsizdir. Bu araştırmanın amacı KOAH hastalarında egzersiz kapasitesi, dispne düzeyi ve yaşam kalitesinin uzun dönem mortalite riskini değerlendirmektir. Materyal ve Metod: Dispne düzeyi “Değiştirilmiş Tıbbi Araştırma Konseyi” (modified Medical Research Council, mMRC), Borg ve Bazal Dispne İndeksi (BDI) ve Vücut Obstrüksiyonu Dispne Egzersizi (BODE), yaşam kalitesi St. George’s Solunum Anketi ve egzersiz kapasitesi 6-dakika yürüme testi (6DYT) ve kardiyopulmoner egzersiz testi ile değerlendirildi. Sekiz-yıllık izlem süresinin sonunda bu testler ve mortalite arasındaki ilişki değerlendirildi. Bulgular: Kırk iki stabil KOAH olgusu araştırmaya alındı. Sekiz-yıllık izlemde 16 hasta öldü. Tek değişkenli analizde pik VO2 [HR: 1.845; CI: (1.336-2.55); p< 0.001], BODE index [HR: 0.787; CI: (0.703-0.880); p< 0.001] ve SGRQ [HR: 1.073; CI: (1.028-1.119); p= 0.001] mortalite riskiyle ilişkili bulundu. Çok değişkenli Cox regresyon analizine gore pik VO2 mortalitenin en anlamlı göstergesiydi [HR: 1.031; CI: (0.683-1.120); p= 0.01]. ROC analizinde pik VO2 < 22.5 değerinin %82 duyarlılık, %80 özgüllük ve 0.142 [95% CI: (0.027-0.257); p< 0.001] AUC değeriyle mortalite riskini gösterdiği saptandı. Sonuç: Maksimal egzersiz sırasında ortaya çıkan kardiyopulmoner kısıtlılıklar uzun dönem mortalite riskinin en önemli göstergesidir.

Does exercise capacity, dyspnea level, or quality of life actually predict mortality in patients with COPD? 8-year follow-up

Introduction: The goals of chronic obstructive pulmonary disease (COPD)treatment are to relieve dyspnea, increase exercise capacity, and improvequality of life. The relation of exercise capacity, dyspnea level, and quality oflife with long-term mortality is unclear. Aim of the study was to assess theeffect of exercise capacity, dyspnea level and quality of life on long-termmortality risk in patients with COPD.Materials and Methods: Dyspnea level was assessed using the modifiedMedical Research Council (mMRC), Borg and Baseline Dyspnea Index (BDI)and Body Obstruction Dyspnea Exercise (BODE), health-related quality of lifewith St. George’s Respiratory Questionnaire, and exercise capacity with the6-minute walking test (6MWT) and cardiopulmonary exercise test. At the endof 8-year follow-up period, the relation between these tests and mortality wasexamined.Results: A total of 42 patients with stable COPD were included in the study.Sixteen patients died during the approximately 8-year follow-up period.Univariate analysis revealed that VO2 peak [HR: 1.845; CI: (1.336-2.55); p

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