PROGNOSTIC VALUE OF HYPERCAPNIA IN PATIENTS WITH CHRONIC RESPIRATORY-FAILURE DURING LONG-TERM OXYGEN-THERAPY

Hypercapnia observed in patients with chronic respiratory failure may not be an ominous sign for prognosis when they are receiving long-term oxygen therapy (LTOT). In this study, we selected 4,552 patients with chronic obstructive pulmonary disease (COPD) and 3,028 with sequelae of pulmonary tuberculosis (TBsq) receiving LTOT from 1985 to 1993 thro ughout Japan and prospectively analyzed their prognoses. The hypercapn ic patients (Pa-CO2 greater than or equal to 45 mm Hg) had a better pr ognosis than the normocapnic patients (35 less than or equal to Pa-CO2 < 45 mm Hg) for TBsq, but no difference was found between the two gro ups with COPD. Furthermore, Cox's proportional hazards model revealed that in TBsq hypercapnia was an independent factor for favorable progn osis, and that the relative risk for mortality was 0.76 in patients wi th 45 less than or equal to Pa-CO2 < 55 mm Hg, 0.64 for those with 55 less than or equal to Pa-CO2 < 65 mm Hg, and 0.49 for patients with Pa -CO2 greater than or equal to 65 mm Hg against normocapnic patients. T his favorable effect of hypercapnia in TBsq was particularly apparent in the patients without severe airway obstruction. Even a rise of 5 mm Hg or more in Pa-CO2 over the initial 6- to 18-mo follow-up period wa s not associated with poor prognosis in TBsq, although it was in COPD. From these findings, we conclude that hypercapnia should not be gener ally considered an ominous sign for prognosis in those patients who re ceive LTOT.