title: Analysis of the relationship between health status and mortality in hypercapnic patients with noninvasive ventilation.
abstract: BACKGROUND
  Health status and mortality are important outcomes in patients with advanced pulmonary diseases receiving noninvasive ventilation (NIV). However, their relationship has not been thoroughly investigated.
  
  
  METHODS
  The present study prospectively recruited 56 stable outpatients treated with NIV for chronic hypercapnic respiratory failure caused by chronic obstructive pulmonary disease and/or pulmonary tuberculosis sequelae. At baseline, health status was measured by the Medical Outcomes Study 36-item short form, a generic questionnaire; the St. George's Respiratory Questionnaire (SGRQ), a respiratory-specific questionnaire; and two respiratory failure-specific questionnaires, the Maugeri Respiratory Failure questionnaire and the Severe Respiratory Insufficiency (SRI) questionnaire. Arterial blood gas, pulmonary function, dyspnea and psychological status were also measured.
  
  
  RESULTS
  In cross-sectional comparisons of the four health status questionnaires, the SGRQ and SRI questionnaire had lower floor and ceiling effects. During the 3-year follow-up, 16 patients (29%) died. Health status shown by the SGRQ and SRI was significantly predictive of mortality, independently of the physiological measures of low body mass index (BMI), hypercapnia, and low pulmonary function. Stepwise multivariate analyses indicated that the SRI summary score was the most significant predictor of mortality (P = 0.0006) followed by BMI (P = 0.012).
  
  
  CONCLUSIONS
  There was a significant relationship between health status and 3-year mortality in patients with NIV, independently of under-nutrition, hypercapnia and low pulmonary function. Health status measurement is important not only to comprehensively evaluate disease severity in relation to its close association with mortality, but also to elucidate factors that improve the survival of patients with advanced respiratory diseases.
authors.affiliation: Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Oga
authors.affiliation: Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Osaka, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Kita
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Minami-Kyoto Hospital, Kyoto, Japan.
authors.forename: Tomomasa
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
authors.affiliation: Department of Pulmonary Medicine, Ogaki Municipal Hospital, Gifu, Japan.
authors.forename: Morihide
authors.initials: M
authors.lastname: Ando
authors.affiliation: Department of Respiratory Medicine, Komaki City Hospital, Aichi, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kojima
authors.affiliation: Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Hyogo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Tomioka
authors.affiliation: Department of Respiratory Medicine, Tenri Hospital, Nara, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Taguchi
authors.affiliation: Department of Respiratory Medicine, Tenri Hospital, Nara, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kaji
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Toneyama Hospital, Osaka, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Maekura
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Toneyama Hospital, Osaka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hiraga
authors.affiliation: Department of Respiratory Medicine, Otsu Red Cross Hospital, Shiga, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sakai
authors.affiliation: Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
authors.affiliation: Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D007564:Japan / Q000453:epidemiology; D008168:Lung / Q000473:pathology / Q000503:physiopathology; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000523:psychology / Q000628:therapy*; D016019:Survival Analysis; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000503:physiopathology / Q000628:therapy
keywords: noninvasive ventilation - health status - mortality - COPD - pulmonary tuberculosis sequelae - chronic hypercapnic respiratory failure