PREDICTORS OF SURVIVAL IN PATIENTS RECEIVING DOMICILIARY OXYGEN-THERAPY OR MECHANICAL VENTILATION - A 10-YEAR ANALYSIS OF ANTADIR OBSERVATORY

Study objective: To analyze predictors of survival for patients receiv ing home long-term oxygen therapy (LTOT) or prolonged mechanical venti lation (PMV) according to the cause of chronic respiratory insufficien cy (CRI) and the patient's physiologic data. Design: Analysis of a nat ionwide database (ANTADIR Observatory). Setting: The national nonprofi t network for home treatment of patients with CRI Association National e pour le Traitement a Domicile de l'Insuffisance Respiratoire Chroniq ue (ANTADIR): founded in France in the 1980s. Patients: There were 26, 140 patients receiving LTOT or PMV (noninvasive or via tracheostomy) b etween January 1, 1984 and January 1, 1993 (chronic bronchitis, 12,043 ; asthma, 1,755; bronchiectasis, 1,556; emphysema, 551; tuberculosis s equelae, 4,147; kyphoscoliosis, 1,574; neuromuscular diseases, 1,097; pneumoconiosis, 919; and fibrosis, 2,498). Measurements and results: S urvival analysis was performed using the actuarial and the Cox's semip arametric model. The mean survival for patients with chronic bronchiti s is 3 years. Survival is slightly better for patients with bronchiect asis and asthma and worse for those with emphysema. Patients with kyph oscoliosis and a neuromuscular disease have the longest survival (8 an d 6.5 years, respectively). Patients with CRI due to tuberculosis sequ elae experience the same survival as COPD patients (3 years). Prognosi s is the worst in patients with pneumoconiosis or fibrosis: 50% of the se patients die during the rear following the beginning of home treatm ent. The association of an obstructive lung disease worsens the progno sis of patients with kyphoscoliosis or neuromuscular disease and tends to bring the survival rate of the patients with pneumoconiosis or fib rosis closer to that of COPD patients. In COPD, male sex, older age, l ower body mass index (BMI), FEV(1) percent predicted, PaO2, and PaCO2 are independent negative prognostic factors. For tuberculous sequelae and kyphoscoliosis, female sex, younger age, a high BMI, PaO2, and PaC O2 (and for kyphoscoliosis a higher FEV(1)/vital capacity [VC] ratio) are all independent favorable prognostic factors. In pulmonary fibrosi s, a lower PaO2 and PaCO2 values, a lower VC percent predicted, and a higher FEV(1)/VC ratio are negative prognostic factors. Conclusions: T he ANTADIR Observatory allows a unique opportunity to analyze long-ter m survival of a large population with CRI treated at home.