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Multicenter Study
. 2022;101(4):353-366.
doi: 10.1159/000519750. Epub 2021 Nov 19.

Value of Cardiopulmonary Exercise Testing in the Prognosis Assessment of Chronic Obstructive Pulmonary Disease Patients: A Retrospective, Multicentre Cohort Study

Ralf Ewert  1 , Anne Obst  1 , Andreas Mühle  2 , Michael Halank  3 , Jörg Winkler  4 , Bernd Trümper  5 , Gerhard Hoheisel  4 , Andreas Hoheisel  6 , Mark Wiersbitzky  7 , Alexander Heine  1 , Alexander Maiwald  1 , Sven Gläser  1   8 , Beate Stubbe  1
Affiliations
Multicenter Study

Value of Cardiopulmonary Exercise Testing in the Prognosis Assessment of Chronic Obstructive Pulmonary Disease Patients: A Retrospective, Multicentre Cohort Study

Ralf Ewert et al. Respiration. 2022.

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases associated with high mortality. Previous studies suggested a prognostic role for peak oxygen uptake (VO2peak) assessed during cardiopulmonary exercise testing (CPET) in patients with COPD. However, most of these studies had small sample sizes or short follow-up periods, and despite their relevance, CPET parameters are not included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) tool for assessment of severity.

Objectives: We therefore aimed to assess the prognostic value of CPET parameters in a large cohort of outpatients with COPD.

Methods: In this retrospective, multicentre cohort study, medical records of patients with COPD who underwent CPET during 2004-2017 were reviewed and demographics, smoking habits, GOLD grade and category, exacerbation frequency, dyspnoea score, lung function measurements, and CPET parameters were documented. Relationships with survival were evaluated using Kaplan-Meier analysis, Cox regression, and receiver operating characteristic (ROC) curves.

Results: Of a total of 347 patients, 312 patients were included. Five-year and 10-year survival probability was 75% and 57%, respectively. VO2peak significantly predicted survival (hazard ratio: 0.886 [95% confidence interval: 0.830; 0.946]). The optimal VO2peak threshold for discrimination of 5-year survival was 14.6 mL/kg/min (area under ROC curve: 0.713). Five-year survival in patients with VO2peak <14.6 mL/kg/min versus ≥ 14.6 mL/kg/min was 60% versus 86% in GOLD categories A/B and 64% versus 90% in GOLD categories C/D.

Conclusions: We confirm that VO2peak is a highly significant predictor of survival in COPD patients and recommend the incorporation of VO2peak into the assessment of COPD severity.

Keywords: All-cause mortality; Cardiopulmonary exercise testing; Chronic obstructive pulmonary disease; Lung function; Prognosis.

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Conflict of interest statement

R.E. received honoraria for scientific lectures from Actelion, GSK, United Therapeutics, AstraZeneca, Novartis, Berlin-Chemie, Boehringer Ingelheim, and OMT, and research funding from Boehringer Ingelheim and Actelion, Germany. M.H. received personal fees for lectures and consultations and travel, accommodation, and/or meeting expenses from Actelion, AOPOrphan/OMT, AstraZeneca, Bayer, Berlin-Chemie, Boehringer, GILEAD, GSK, MSD, Novartis, and Pfizer. G.H. received honoraria for scientific lectures from GSK, AstraZeneca, Novartis, Berlin-Chemie, and Boehringer Ingelheim. S.G. received honoraria for scientific lectures from AstraZeneca, Novartis, Berlin-Chemie, Boehringer Ingelheim, and Roche. A.O., A.Mü, J.W., B.T., A.Ho, M.W., A.He, A.Ma, B.S: No potential conflict of interest to report.

Figures

Fig. 1
Fig. 1
Patient flow. COPD, chronic obstructive pulmonary disease; CPET, cardiopulmonary exercise testing; FEV1, forced expiratory volume in 1 s.
Fig. 2
Fig. 2
All-cause mortality according to GOLD grades. GOLD, global initiative for chronic obstructive lung disease.
Fig. 3
Fig. 3
Survival according to the mBODE index (n = 275). mBODE, modified BMI, airflow obstruction, dyspnoea, and exercise capacity.
Fig. 4
Fig. 4
Survival according to individual components of the mBODE index (n = 275). BMI, body mass index; FEV1, forced expiratory volume in 1 s; mBODE, modified BMI, airflow obstruction, dyspnoea, and exercise capacity; mMRC, modified medical research council dyspnoea scale; VO2peak, peak oxygen uptake.
Fig. 5
Fig. 5
VO2peak for discrimination of survival at 5 years. In ROC analysis (upper panels), VO2peak = 14.6 mL/kg/min and VO2peak = 55% predicted were identified as the optimal thresholds for prediction of survival at 5 years. Kaplan-Meier plots (lower panels) show survival in patient subgroups defined based on these thresholds. AUC, area under the curve (reported with 95% confidence interval); VO2peak, peak oxygen uptake; ROC, receiver operating characteristic.
Fig. 6
Fig. 6
ROC analysis of VO2peak and multidimensional prognostic indices for discrimination of survival at 3 (left) and 5 (right) years. ADO, age, dyspnoea, and airflow obstruction; AUC, area under the curve (reported with 95% confidence interval); DOSE, dyspnoea, airflow obstruction, current smoking status, and exacerbations; mBODE, modified BMI, airflow obstruction, dyspnoea, and exercise capacity; VO2peak, peak oxygen uptake; ROC, receiver operating characteristic.
Fig. 7
Fig. 7
Kaplan-Meier analysis of survival in patients stratified by GOLD category and VO2peak. GOLD, global initiative for chronic obstructive lung disease; VO2peak, peak oxygen uptake.
Fig. 8
Fig. 8
Suggested inclusion of VO2peak in the GOLD ABCD refined assessment tool. COPD, chronic obstructive pulmonary disease assessment test; GOLD, global initiative for chronic obstructive lung disease; mMRC, modified medical research council dyspnoea scale; VO2peak, peak oxygen uptake.
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