title: Survival of patients with chronic respiratory failure on long-term oxygen therapy and or non-invasive ventilation at home.
abstract: OBJECTIVE
  Chronic respiratory failure (CRF) is the common fate of respiratory diseases where systemic effects contribute to outcomes. In a prospective cohort of home-treated patients with CRF, we looked for predictors of long-term survival including respiratory, nutritional and inflammatory dimensions.
  
  
  METHODS
  637 stable outpatients with CRF, 397 men, 68 ± 11 years, on long-term oxygen therapy and/or non-invasive ventilation from 21 chest clinics were enrolled and followed over 53 ± 31 months. CRF resulted from Chronic Obstructive Pulmonary Disease (COPD) in 48.5%, restrictive disorders 32%, mixed (obstructive and restrictive patterns) respiratory failure 13.5%, bronchiectasis 6%. Demographic characteristics, smoking habits, underlying respiratory diseases, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), arterial blood gases, 6-min walking distance (6MWD), hemoglobin, body mass index (BMI), serum albumin, transthyretin, C-reactive protein (CRP), history of respiratory assistance, antibiotic and oral corticosteroid use during the previous year were recorded.
  
  
  RESULTS
  322 deaths occurred during the follow-up. One-, five- and 8-year actuarial survival was 89%, 56% and 47%. By Cox univariate analysis, age, respiratory disease, PaO2, PaCO2, FEV1/FVC, BMI, 6MWD, activity score, type and length of home respiratory assistance, smoking habits, oral corticosteroid and antibiotic uses, albumin, transthyretin, hemoglobin and CRP levels were associated with survival. Multivariate analysis identified eight independent markers of survival: age, FEV1/FVC, PaO2, PaCO2, 6MWD, BMI, serum transthyretin, CRP ≥ 5 mg/l.
  
  
  CONCLUSIONS
  In CRF, whatever the underlying diseases, besides the levels of obstructive ventilatory defect and gas exchange failure, 6MWD, BMI, serum transthyretin and CRP ≥ 5 mg/l predicted long-term survival identifying potential targets for nutritional rehabilitation.
authors.affiliation: CHU Clermont-Ferrand, Service de Nutrition, F-63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000 Clermont-Ferrand, France; INRA, UMR 1019, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France.
authors.forename: Noël J
authors.initials: NJ
authors.lastname: Cano
authors.affiliation: Université Genève, CH-1201 Genève, Switzerland; Nutrition Clinique, Hôpitaux Universitaires de Genève, CH-1201 Genève, Switzerland.
authors.forename: Claude
authors.initials: C
authors.lastname: Pichard
authors.affiliation: CHU Saint-Étienne, Service de Pneumologie, F-42000 Saint-Etienne, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Court-Fortune
authors.affiliation: CHU Saint-Étienne, Service de Physiologie Clinique et de l'Exercice, Hôpital Nord, F-42000 Saint-Etienne, France; Université Jean Monnet, Laboratoire Physiologie de l'Exercice, EA4338, F-42000 Saint-Etienne, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Costes
authors.affiliation: Service de Biochimie, Hôpitaux Universitaires Paris Centre, F-75014 Paris, France; EA 4466, Département de Biologie Expérimentale, Métabolique et Clinique, Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, F-75006 Paris, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Cynober
authors.affiliation: Hospices civils de Lyon, Service de Nutrition Clinique Interne, Hôpital de la Croix Rousse, F-69317 Lyon, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Gérard-Boncompain
authors.affiliation: CHU Rouen, Service de Pneumologie et Soins Intensifs Respiratoires, F-76000 Rouen, France; Université Rouen, EA3830 IFR MP23, F-76000 Rouen, France.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Molano
authors.affiliation: CHU Rouen, Service de Pneumologie et Soins Intensifs Respiratoires, F-76000 Rouen, France; Université Rouen, EA3830 IFR MP23, F-76000 Rouen, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Cuvelier
authors.affiliation: Service de Pneumologie et de Réanimation Respiratoire, Hôtel-Dieu, F-75004 Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laaban
authors.affiliation: Unité de Nutrition Clinique, Pôle médecine aiguë inflammation infection, Hôpital Raymond Poincaré, EA 44-97, UVSQ, F-92380 Garches, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Melchior
authors.affiliation: Département de Réanimation Médicale, Hôpital Raymond Poincaré, F-92380 Garches, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Raphaël
authors.affiliation: CHU Grenoble, Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, F-38000 Grenoble, France.
authors.forename: Julie
authors.initials: J
authors.lastname: France
authors.affiliation: CHU Grenoble, Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, F-38000 Grenoble, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lloret
authors.affiliation: CHU Grenoble, Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, F-38000 Grenoble, France; Université Grenoble Alpes, F-38000 Grenoble, France; InsermU1055, F-38000 Grenoble, France; CRNH Rhône-Alpes, F-69310 Pierre-Bénite, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Roth
authors.affiliation: CHU Grenoble, Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, F-38000 Grenoble, France; Université Grenoble Alpes, F-38000 Grenoble, France; InsermU1055, F-38000 Grenoble, France; European Institute of Systems Biology and Medicine, F-69000 Lyon, France. Electronic address: cpison@chu-grenoble.frmailto.
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063087:Noninvasive Ventilation / Q000379:methods*; D010100:Oxygen / Q000627:therapeutic use*; D011228:Prealbumin / Q000378:metabolism; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; D006454:Hemoglobins; D011228:Prealbumin; D012709:Serum Albumin; D002097:C-Reactive Protein; D010100:Oxygen
keywords: C-reactive protein; Chronic obstructive; Hypoxemia; Nutrition; Pulmonary disease; Transthyretin