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C-Reactive Protein and Body Mass Index Predict Outcome in End-Stage Respiratory Failure^*

^* From the Département de Nutrition (Dr. Cano), Clinique Résidence du Parc, Marseille, France; Service de Nutrition Clinique (Dr. Pichard), Hôpitaux Universitaire de Genève, Genève, Switzerland; Département de Médecine Aiguë Spécialisée (Mr. Roth and Dr. Pison), CHU, Grenoble, France; Service de Pneumologie (Dr. Court-Fortuné), CHU, Saint-Etienne, France; Service de Biochimie A (Dr. Cynober), AP-HP, Hôtel-Dieu, Paris, France; Service de Réanimation Médicale et d’Assistance Respiratoire (Dr. Gérard-Boncompain), HCL, Lyon, France; Service de Pneumologie (Dr. Cuvelier), CHU, Rouen, France; Service de Pneumologie et de Réanimation Respiratoire (Dr. Laaban), AP-HP, Hôtel-Dieu, Paris, France; Service des Maladies Infectieuses (Dr. Melchior), AP-HP, Hôpital Raymond Poincaré, Garches, France; and Service de Réanimation Médicale (Dr. Raphaël), AP-HP, Hôpital Raymond Poincaré, Garches, France.

Correspondance to: Noël J. M. Cano, MD, PhD, Département de Nutrition, Clinique Résidence du Parc, Rue Gaston Berger, 13010 Marseille, France; e-mail: njm.cano{at}wanadoo.fr

Study objective: To determine the predictive factors of morbidity and mortality in patients with end-stage respiratory disease.

Design: Prospective, multicenter cohort study.

Setting: Thirteen outpatient chest clinics within the Association Nationale de Traitement à Domicile de l’Insuffisance Respiratoire.

Participants: Stable adult patients with chronic respiratory failure receiving long-term oxygen therapy and/or home mechanical ventilation (n = 446; 182 women and 264 men; aged 68.5 ± 12.1 years [± SD]); Respiratory diseases were COPD in 42.8%, restrictive disorders in 36.3%, mixed respiratory failure in 13.5%, and bronchiectasis in 7.4%. Recruitment was performed during the yearly examination. Patients with neuromuscular diseases and sleeping apnea were excluded.

Measurements and results: Hospitalization days and survival were recorded during a follow-up of 14.3 ± 5.6 months. Body mass index (BMI), serum albumin, and transthyretin levels were considered for their predictive value of outcome, together with demographic data, underlying respiratory disease, respiratory function, hemoglobin, C-reactive protein, smoking habits, oral corticosteroid use, and antibiotic treatment courses. Overall, 1.8 ± 1.7 hospitalizations (cumulative stay, 17.6 ± 27.1 days) were observed in 254 of 446 patients (57%). Independent predictors of hospitalization were oral corticosteroids, FEV₁, and plasma C-reactive protein. One-year and 2-year cumulative survivals were 93% and 69%, respectively. Plasma C-reactive protein, BMI, PaO₂ on room air, and oral corticosteroids independently predicted survival in multivariate analysis.

Conclusion: Besides established prognosis factors such as FEV₁ and PaO₂, nutritional depletion as assessed by BMI and overall systemic inflammation as estimated by C-reactive protein appear as major determinants of hospitalization and death risks whatever the end-stage respiratory disease. BMI and C-reactive protein should be included in the monitoring of chronic respiratory failure. Oral corticosteroids as maintenance treatment in patients with end-stage respiratory disease are an independent risk factor of death, and should be avoided in most cases.

Key Words: body mass index • C-reactive protein • long-term oxygen therapy • noninvasive ventilation • survival

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