Oxygen desaturation during a 6-minute walk test as a predictor of maximal exercise-induced gas exchange abnormalities in sarcoidosis.
BACKGROUND
Common tests for evaluating gas exchange impairment have different strengths and weaknesses. Alveolar-to-arterial oxygen pressure difference (AaDO2) at peak exercise is a sensitive indicator but it cannot be measured repeatedly. Diffusing capacity of the lung for carbon monoxide (DLco) is measured at rest and may be too insensitive to predict the effects of exercise on gas exchange impairment. Oxygen desaturation during a 6-minute walk test (∆SpO2-6MWT) can be measured repeatedly, but its value in sarcoidosis is unknown. Here, we evaluated the ability of ∆SpO2-6MWT and DLco to predict gas exchange impairment during exercise in sarcoidosis.


METHODS
This retrospective study of 130 subjects with sarcoidosis investigated the relationship between DLco, ∆SpO2-6MWT, and peak AaDO2 using correlation tests, inter-test reliability analyses, and predictive values. For the analyses of inter-test reliability and predictive values, DLco, peak AaDO2, and ∆SpO2-6MWT were considered as binary variables (normal/abnormal) according to previously defined thresholds.


RESULTS
Correlation coefficients between DLco, ∆SpO2-6MWT, and peak AaDO2 were intermediate (0.53-0.67, P<0.0003) and Kappa coefficients were low (0.21-0.42, P=0.0003-0.02). DLco predicted (I) increased peak AaDO2 with a positive predictive value (PPV) of 66% and a negative predictive value (NPV) of 78% and (II) increased ∆SpO2-6MWT with a PPV at 36% and an NPV at 88%. Normal DLco was a good predictor of the absence of severe desaturation during the 6MWT (94% NPV) and at peak exercise during cardiopulmonary exercise test (CPET) (100% NPV). ∆SpO2-6MWT predicted peak AaDO2 increase with a PPV of 74% and an NPV of 60%.


CONCLUSIONS
In a large population of sarcoidosis patients, neither ∆SpO2-6MWT nor DLco was a good predictor of increased peak AaDO2. In contrast, normal DLco was a good predictor of the absence of severe desaturation during the 6MWT and at peak exercise during CPET.
Department of Respiratory Medicine, Rare Disease Center, Univ. Lille, F-59000 Lille, France.
Cecile
C
Chenivesse
Department of Respiratory Medicine, Rare Disease Center, Univ. Lille, F-59000 Lille, France.
Sarah
S
Boulanger
Department of Biostatistics, Univ. Lille, F-59000 Lille, France.
Carole
C
Langlois
Department of Respiratory Medicine, Rare Disease Center, Univ. Lille, F-59000 Lille, France.
Lidwine
L
Wemeau-Stervinou
Department of Respiratory Medicine, Rare Disease Center, Univ. Lille, F-59000 Lille, France; Lung Function Department, Univ. Lille, F-59000 Lille, France.
Thierry
T
Perez
Department of Respiratory Medicine, Rare Disease Center, Univ. Lille, F-59000 Lille, France.
Benoit
B
Wallaert
6-minute walk test (6MWT); Sarcoidosis; alveolar-arterial oxygen gradient; cardiopulmonary exercise test (CPET); diffusing capacity; pulmonary gas exchange