en
Scientific article
English

Long-Term Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: Association between Clinical Phenotypes and Survival

Published inRespiration, vol. 101, no. 10, p. 939-947
Publication date2022
First online date2022-08-26
Abstract

Background: Long-term noninvasive ventilation (LTNIV) is widely used in patients with chronic hypercapnic respiratory failure (CHRF) related to COPD. Prognosis of these patients is however poor and heterogenous.

Research question: In COPD patients under LTNIV for CHRF, is it possible to identify specific phenotypes which are predictive of probability of pursuing NIV and survival?

Study design and methods: A latent class analysis was performed in a COPD population under LTNIV included in a comprehensive database of patients in the Geneva Lake area, to determine clinically relevant phenotypes. The observation period of this subgroup of COPD was extended to allow assessment of survival and/or pursuit of NIV for at least 2 years after inclusion. A logistic regression was conducted to generate an equation accurately attributing an individual patient to a defined phenotype. The identified phenotypes were compared on a series of relevant variables, as well as for probability of pursuing NIV or survival. A competitive risk analysis allowed to distinguish death from other causes of cessation of NIV.

Results: Two phenotypes were identified: a "respiratory COPD" profile with very severe airway obstruction, a low or normal body mass index, and a low prevalence of comorbidities and a "systemic COPD" profile of obese COPDs with moderate airway obstruction and a high rate of cardiovascular and metabolic comorbidities. The logistic regression correctly classified 95.7% of patients studied. Probability of pursuing NIV and survival were significantly related to these phenotypes, with a poorer prognosis for "respiratory COPD." Probability of death 5 years after implementing NIV was 22.3% (95% CI: 15.4-32.2) for "systemic COPD" versus 47.2% (37.4-59.6) for "respiratory COPD" (p = 0.001).

Conclusion: The two distinct phenotypes of COPD under LTNIV for CHRF identified appear to be strongly related to prognosis and require further validation in other cohort studies.

eng
Keywords
  • Chronic hypercapnic respiratory failure
  • Chronic obstructive pulmonary disease
  • Home mechanical ventilation
  • Latent class analysis
  • Long-term mechanical ventilation
  • Overlap syndrome
  • Phenotypes
  • Prognosis
  • Survival
  • Airway Obstruction
  • Humans
  • Hypercapnia / etiology
  • Noninvasive Ventilation
  • Phenotype
  • Pulmonary Disease, Chronic Obstructive / complications
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy
Citation (ISO format)
JANSSENS, Jean-Paul et al. Long-Term Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: Association between Clinical Phenotypes and Survival. In: Respiration, 2022, vol. 101, n° 10, p. 939–947. doi: 10.1159/000525865
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Article (Published version)
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ISSN of the journal0025-7931
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Technical informations

Creation10/06/2022 1:48:00 PM
First validation10/06/2022 1:48:00 PM
Update time03/16/2023 10:52:43 AM
Status update03/16/2023 10:52:43 AM
Last indexation02/01/2024 9:42:48 AM
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