VARIABLES RELATED TO INCREASED MORTALITY FOLLOWING OUTPATIENT PULMONARY REHABILITATION

Although patients with advanced pulmonary disease have significant imp rovement in exercise ability and functional status following comprehen sive out-patient pulmonary rehabilitation (OPR), their long-term progn osis once they have reached this stage of their diseases remains poor. To further evaluate predictors of increased mortality in these patien ts, we related patient characteristics and short-term outcome obtained during OPR assessment of 158 patients to subsequent survival, The tim e period from OPR to death or collection of survival data was 40.0+/-1 7.1 months. The following variables were tested individually and in st epwise fashion using a proportional hazards model: 1) I USA age; 2) ge nder; 3) pulmonary diagnosis; 4) prebronchodilator forced expiratory v olume in one second (FEV(1)); 5) arterial oxygen tension (Pao(2) and a rterial carbon dioxide tension (Pa,CO2); 6) body mass index (BMI); 7) pre- and post-OPR 12 min walking distance (12-MW); 8) pre- and post-OP R quality of life, using the Chronic Respiratory Disease Questionnaire (CRDQ); 9) number and type of nonpulmonary diagnoses; and 10) number of medications, Separate survival analyses were performed for all deat hs (the total group), respiratory deaths only (nonrespiratory deaths e xcluded), and nonrespiratory deaths only (respiratory deaths excluded) . Forty three patients (27%) died during the study period; and the 3 y ear survival was 80%. For all three survival analyses, the post-OPR 12 -MW was the most significant variable related to prognosis: patients w ith low timed walking distance had increased mortality both from respi ratory and nonrespiratory causes, Other variables related to increased mortality included: elevated PaCO2; low pre-OPR 12-MW; reduced PaO2; low FEV(1); low BMI, increased number of medications, and increased CR DQ dyspnoea. These results indicate that the timed walking distance fo llowing out-patient pulmonary rehabilitation is an important predictor of survival in patients with advanced pulmonary disease. (C)ERS Journ als Ltd. 1996.