Cardiopulmonary Exercise Testing Provides Prognostic Information in Advanced Cystic Fibrosis Lung Disease
Year: 2023
Type: article
Study design: Observational Study
Abstract: Rationale Cardiopulmonary exercise testing (CPET) provides prognostic information in cystic fibrosis (CF); however, its prognostic value for patients with advanced CF lung disease is unknown. Objectives To determine the prognostic value of CPET on the risk of death or lung transplant (LTX) within 2 years. Methods We retrospectively collected data from 20 CF centers in Asia, Australia, Europe, and North America on patients with a forced expiratory volume in 1 second (FEV1) ⩽ 40% predicted who performed a cycle ergometer CPET between January 2008 and December 2017. Time to death/LTX was analyzed using mixed Cox proportional hazards regression. Conditional inference trees were modeled to identify subgroups with increased risk of death/LTX. Results In total, 174 patients (FEV1, 30.9% ± 5.8% predicted) were included. Forty-four patients (25.5%) died or underwent LTX. Cox regression analysis adjusted for age, sex, and FEV1 revealed percentage predicted peak oxygen uptake (V˙o2peak) and peak work rate (Wpeak) as significant predictors of death/LTX: adjusted hazard ratios per each additional 10% predicted were 0.60 (95% confidence interval, 0.43–0.90; P = 0.008) and 0.60 (0.48–0.82; P < 0.001). Tree-structured regression models, including a set of 11 prognostic factors for survival, identified Wpeak to be most strongly associated with 2-year risk of death/LTX. Probability of death/LTX was 45.2% for those with a Wpeak ⩽ 49.2% predicted versus 10.9% for those with a Wpeak > 49.2% predicted (P < 0.001). Conclusions CPET provides prognostic information in advanced CF lung disease, and Wpeak appears to be a promising marker for LTX referral and candidate selection.
Authors: Thomas Radtke, Don S. Urquhart, Julia Braun, Peter J. Barry, Ian Waller, Nicole Petch, Meir Mei-Zahav, Mordechai R. Kramer, Thong Hua-Huy, Anh Tuan Dinh-Xuan, J. Alastair Innes, Sara McArthur, Aleksandar Sovtic, Bojana Gojsina, Samuel Verges, Tanguy de Maat, Lisa Morrison, Jamie Wood, Samantha Crute, Craig A. Williams, Owen W. Tomlinson, Ronen Bar-Yoseph, Alexandra Hebestreit, Bradley S. Quon, Eugenie Kwong, Zoe L. Saynor, Adam J. Causer, Anne L. Stephenson, Jane E. Schneiderman, Michelle Shaw, Tiffany Dwyer, Daniel Stevens, Natascha Remus, Benoit Douvry, Karla Foster, Christian Benden, Felix Ratjen, Helge Hebestreit
Institutions: University of Zurich, Prevention Institute, University of Edinburgh, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Tel Aviv University, Rabin Medical Center, Schneider Children's Medical Center, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris, Université Paris Descartes, Western General Hospital, NHS Lothian, University of Belgrade, Inserm, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, Queen Elizabeth University Hospital, Sir Charles Gairdner Hospital, Icahn School of Medicine at Mount Sinai, University of Exeter, Royal Devon University Healthcare NHS Foundation Trust, Technion – Israel Institute of Technology, Rambam Health Care Campus, Universitätsklinikum Würzburg, University of British Columbia, St. Paul's Hospital, University Hospital Southampton NHS Foundation Trust, University of Portsmouth, St. Michael's Hospital, Great Ormond Street Hospital, Hospital for Sick Children, University of Toronto, The University of Sydney, Royal Prince Alfred Hospital, Dalhousie University, Université Paris-Est Créteil, Hôpital Intercommunal de Créteil, Cincinnati Children's Hospital Medical Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Award: G2968883502
OpenAlex ID: W4387949622