Surgery and transplantation.

Fernando J. Martinez, Gregory Foster, Jeffrey L. Curtis, Gerard Criner, Gail Weinmann, Alfred Fishman, Malcolm M.

escape, Joshua Benditt, Frank Sciurba, Barry Make, SAR Mohsenifar, Philip Diaz,

Eric Hoffman and Robert Wise, for the NETT Research Group

Department of Pulmonology and intensive care University of Michigan Health System, Ann Arbor, Michigan, Department of Epidemiology

and Department of Medicine, Johns Hopkins University , Baltimore, Division of Lung Diseases, National Heart, Lung, and Blood Institute

Bethesda, Maryland, office light and Intensive Care, Department of Medicine, Temple University, Philadelphia, Division

light and intensive care University of Pittsburgh, Pittsburgh , Division of Pulmonology and resuscitation

University of Pennsylvania, Philadelphia, Pennsylvania, in the Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts;

Faculty of Medicine, University of Washington, Seattle, Washington, Department of Science Light , National Jewish Medical and

Research Center, Denver, Colorado, Department of Pulmonary Medicine, Cedars-Sinai lasix heart medication Medical Center in Los Angeles, California;

Department of Internal Medicine, The Ohio State University, Columbus, Ohio, and Department of Radiology, University of Iowa, Iowa City, Iowa

patients with predominantly emphysema. (Aged 40-83 years. 64 2% of men) randomized to medical therapy group. Cox proportional

regression analysis was used for

study of risk factors for all-causemortality. Risk factors considered

included demographics, body mass index, physiological data quality

life, dyspnea, oxygen utilization, hemoglobin, smoking,

quantitative emphysema markers on computed tomography, and << Bode >> Fied). Results: Overall, the high mortality rate observed in this group (12 July

deaths per 100 person-years, 292 total deaths.). In multivariate analyzes

age (p 0. 001), use of oxygen (P 0. 04), below

total lung capacity% predicted (p 0. 05), higher residual volume% of the

good (p 0. 04), below the maximum cardio exercise

test load (p 0. 002), most of >> << emphysema in the lower zone of light compared to the upper lung zones (P 0. 005),

top and bottom to the lower lung perfusion ratio (p 0. 007) and

changes Bode (p 0. 02) was predictor of mortality. FEV1 was significantly

ofmortality forerunner in the analysis of one-dimensional (p 0. 005)

but not in multivariate analyzes (p 0. 21). ENCE high mortality, subgroups based on age, oxygen utiliza-

tion, physiologic measures, exercise tolerance and emphysema Ras

contribute to identify those at increased risk of death. with significant morbidity and mortality (1), and a study to determine

(Received in original form October 27, 2005, adopted in final form March 16, 2006)

support contract with the National Heart, Lung, and Blood Institute

(N01HR76101, N01HR76102, N01HR76103, N01HR76104, N01HR76105,

N01HR76106, N01HR76107, N01HR76108, N01HR76109, N01HR76110,

N01HR76111, N01HR76112, N01HR76113, N01HR76114, N01HR76115,

N01HR76116, N01HR76118 and N01HR76119), Centers for Medicare and Medicaid

Services and Agency for Health Care Research and Quality. Correspondence and requests for prints should be addressed to Fernando J. Martinez, MD, MS, 1500 East Medical Center Drive, 3916 Taubman Center

Ann Arbor, MI 48109-0360. E-mail: fmartine @ umich. Education

This article is an online supplement, which is available from the table this issue

content in the WWW. atsjournals. org

Am J Respir Critical Care Med Vol 173. pp. 1326-1334, 2006

First published in print as DOI: 10. 1164/rccm. 200510-1677OC March 16, 2006

Internet address: www. atsjournals. org

(2). Numerous factors are reported to influence prognosis, including

FEV1 (1, 3, 4), inspiratory capacity (5), diffusion mosch-ness

for carbon monoxide (DLCO) (6-8) , hypoxemia (2, 9), hyper-

carbia (2, 7, 8, 10), breach of exercise tolerance (2, 4, 11-15), sex

(16), index body mass (BMI) (4, 17-19), dyspnea (20), and health status >> << (13, 21). Clinical phenotype of patients with COPD

may also affect the prognosis (22), and early researchers suggested

bronchitis or asthma (7, 23). A more reliable predictors of increased risk of death

in advanced COPD would be clinically useful, and

in the study of potential therapeutic interventions. emphysema and severe airway obstruction (24, 25). drug therapy in 17 clinics in the NETT (25), except for one

NETT, for which the transaction date was unknown. A total of 35

NETT, and another 18 609 patients received light trans

Surgery and Transplantation. Design and methods of the trial have been previously

detail, and listed in the online appendix (24

25). All patients gave written informed consent, and research

Expert Council approved organizations in each clinic. Base

because randomization. patient interview using standard tools. Health status was assessed quality

well-being scale, the results of medical research

Short Form 36-item health survey and the St. George Respiratory Questionnaire

history (26). Dyspnea was quantified using

University of California, San Diego, shortness of breath questionnaire (UCSD

SOBQ) (27). Oxygen use was obtained by patient report and

sleep or exercise. measured after administration of albuterol, diffusion capacity,

airway pressure, and arterial blood gases were measured. >>. <<