Chest
Volume 130, Issue 6, December 2006, Pages 1687-1694
Journal home page for Chest

Original Research: COPD
Drawing Impairment Predicts Mortality in Severe COPD

https://doi.org/10.1378/chest.130.6.1687Get rights and content

Background

Cognitive impairment frequently occurs in elderly COPD patients, but little is known about its prognostic implications. We aimed at evaluating the prognostic role of cognitive impairment in patients with severe COPD.

Methods

Our series consisted of 149 stable patients (mean [± SD] age, 68.7 ± 8.5 years) with COPD and a Pao2 of < 57 mm Hg at rest (n = 97) or at the end of the 6-min walking test (n = 37) who were enrolled in a prospective observational study. After a multidimensional baseline assessment, patients were followed up by telephone calls for a mean duration of 32.5 ± 9.2 months (minimal follow-up duration, 24 months); 134 patients were successfully tracked. We used multivariable Cox proportional hazard analysis to identify predictors of death among clinical/functional variables that previously were shown to have prognostic implications and among neuropsychological indexes selected on the basis of univariate analysis.

Results

We observed 29 deaths over a median follow-up time of 32 months. Only the two following variables were independently associated with the outcome: an abnormal score on the copy with landmark test (hazard ratio [HR], 2.93; 95% confidence interval [CI], 1.34 to 6.39); and a 6-min walk distance of < 300 m (HR, 3.46; 95% CI, 1.15 to 10.5). A Pao2 of < 57 mm Hg at rest (HR, 2.19; 95% CI, 0.93 to 5.18) and an FEV1 of < 40% predicted (HR, 2.74; 95% CI, 0.99 to 7.57) were nearly significantly associated with the outcome, while Paco2, body mass index, physical dependence, comorbid diseases, and the impairment of cognitive domains other than drawing impairment were unrelated to the outcome.

Conclusions

Drawing impairment is a risk factor for mortality and might improve the assessment of hypoxemic COPD patients.

Section snippets

Materials and Methods

From October 2000 to May 2002, we consecutively enrolled 149 COPD patients who had undergone a period 40 to 60 days of in-hospital rehabilitation following an acute exacerbation of COPD. At the time of data collection, participants were in stable condition, and their Pao2, Paco2, and personal independence were comparable to those reported before the exacerbation in the ambulatory records. The diagnosis of COPD was made according to American Thoracic Society standards.9 Only patients with a Pao2

Results

We had follow-up information for 134 of 149 participants (90% of the baseline cohort). Patients who were lost to follow-up and those who were successfully tracked had comparable respiratory function test results, clinical/neuropsychological characteristics, and performance status, but patients lost to follow-up were older (mean age, 74.2 ± 5.1 vs 69.0 ± 8.6 years, respectively; F = 3.746 [by analysis of variance]; p = 0.057). Over a cumulative observation period of 4,362 months, 29 participants

Discussion

We found that in patients with severe COPD two nonrespiratory indexes of health status (ie, a low score on the copying of a drawing with landmark test and a low 6MWD) predict mortality. The effect of neuropsychological dysfunction on mortality was independent of arterial hypoxemia, a nearly significant predictor, and the two factors showed only a weak synergy, indicating that the increase in risk in people with both factors is roughly equal to the sum of the risks associated with each of them.

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    All authors have no conflict of interest in the subject matter of the manuscript.

    This study was supported by a grant from the Italian Ministry of Health (Conv. N. ICS 030.8/RF99.42).

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