RU2315552C1 - Method for evaluating two-year survival rate in patients with chronic obstructive pulmonary disease complicated with decompensated or pulmonale chronicum - Google Patents

Abstract

FIELD: medicine, pulmonology.

SUBSTANCE: it is necessary to detect partial pressure of oxygen in arterial blood (pO₂), postbronchodilation value of forced expiratory volume per 1 sec (FEV₁), partial pressure of carbon dioxide in arterial blood (pCO₂), cardiac index of right ventricle (CI RV), index of smoking person (IS), end-diastolic volume of right ventricle (EDV RV), the frequency of COPD exacerbations to calculate the equation of multiple regression: survival rate (mo)=1.94+0.51·pO₂(mm mercury column)+0.71·FEV1(% against due)-0.52·pCO₂(mm mercury column)+6.49·CI RV(l/min/sq/m)-0.25·IS(packs/yr)-0.12·EDV RV(ml)-4.68 ·frequency COPD exacerbations ("1" - in case of exacerbations being less than thrice annually, "2" - thrice and more times annually) to detect two-year survival rate in such patients. The innovation is more simplified and efficient.

EFFECT: higher accuracy of evaluation.

2 ex

Description

The invention relates to medicine, in particular to pulmonology, and can be used to assess the two-year survival of patients with chronic obstructive pulmonary disease (COPD), complicated by decompensated chronic pulmonary heart (CHL), based on determining the risk of death of patients from progressive pulmonary heart disease.

Known methods for predicting the survival of patients with COPD [1, 2, 3], evaluating individual indicators of the cardiorespiratory system, or anamnestic data without taking into account their relationship and interaction, each separately.

The purpose of the invention is to determine the two-year survival of patients with COPD complicated by decompensated chronic pulmonary heart, based on the identification of prognostic survival criteria and their systematic analysis. These indicators are anamnestic and cardiorespiratory indicators, namely the frequency of exacerbations of COPD, the smoker, human index, post-bronchodilation rate of forced expiratory volume in 1 second, the partial pressure of oxygen in arterialized blood, the partial pressure of carbon dioxide in arterialized blood, the cardiac index of the right ventricle, of course diastolic volume of the right ventricle.

The goal is achieved by recording indicators of the frequency of exacerbations of COPD, smoking person index (IR), post-bronchodilation rate of forced expiratory volume in 1 second (FEV ₁ ), partial pressure of oxygen in arterialized blood (pO ₂ ), partial pressure of carbon dioxide in arterialized blood ( pCO ₂ ), cardiac index of the right ventricle (SI RV), end-diastolic volume of the right ventricle (BWC RV), solve the multiple regression equation:

Survival (months) = 1.94 + 0.51 · pO ₂ (mm Hg) + 0.71 · FEV ₁ (% due) -0.52 · pCO ₂ (mm Hg) +6 , 49 · SI RV (l / min / m ² ) -0.25 · IR (packs / year) -0.12 · BWW RV (ml) -4.68 · exacerbations

The claimed method is as follows:

I. determine anamnestic indicators:

1. the frequency of COPD exacerbations: by default, the variable takes the value “1” - for exacerbations less than 3 times a year, “2” - 3 or more times a year;

2. smoking person index (PC, packs / year);

II. register indicators of the cardiorespiratory system:

1. post-bronchodilation rate of forced expiratory volume in 1 second (FEV ₁ ,% due);

2. partial pressure of oxygen in arterialized blood (pO ₂ , mmHg);

3. partial pressure of carbon dioxide in arterialized blood (pCO ₂ , mm Hg);

4. heart index of the right ventricle (SI RV, l / min / m ² );

5. end-diastolic volume of the right ventricle (BWW RV, ml).

The following are examples of the use of the claimed method.

Example 1

Patient P., 67 years old. Clinical diagnosis: Chronic obstructive pulmonary disease, extremely severe course, stage of exacerbation. Emphysema. Diffuse pneumosclerosis. Respiratory failure III degree. Chronic pulmonary heart, decompensation stage. Circulatory failure IIB stage.

- The partial pressure of oxygen in arterialized blood is 64.8 mm Hg;

- postbronchodilation indicator of forced expiratory volume in 1 second - 25% to the proper values;

- partial pressure of carbon dioxide in arterialized blood - 47.3 mm Hg;

- cardiac index of the right ventricle - 2.88 l / min / m ² ;

- smoking person index - 43 packs / year;

- end-diastolic volume of the right ventricle - 147 ml;

- the frequency of exacerbations of COPD is more than 3 times a year.

To determine survival, the multiple regression equation is solved:

Survival rate = 1.94 + 0.51 · 64.8 + 0.71 · 25-0.52 · 47.3 + 6.49 · 2.88-0.25 · 43-0.12 · 147-4, 682

The result of survival is 9.04 months.

Example 2

Patient K., 75 years old. Clinical diagnosis: Chronic obstructive pulmonary disease, severe course, stage of exacerbation. Emphysema. Diffuse pneumosclerosis. Respiratory failure II degree. Chronic pulmonary heart, decompensation stage. Circulatory failure of the Central Bank stage.

- The partial pressure of oxygen in arterialized blood is 69 mm Hg;

- postbronchodilation indicator of forced expiratory volume in 1 second - 43% of the proper values;

- partial pressure of carbon dioxide in arterialized blood - 38 mm Hg;

- cardiac index of the right ventricle - 3.73 l / min / m ² ;

- smoking person index - 10 packs / year;

- end-diastolic volume of the right ventricle - 130 ml;

- the frequency of exacerbations of COPD is more than 3 times a year.

To determine survival, the multiple regression equation is solved:

Survival rate = 1.94 + 0.51 · 69 + 0.71 · 43-0.52 · 38 + 6.49 · 3.73-0.25 · 10-0.12 · 130-4.68 · 2

The survival result is 44.6 months.

Using this method will allow using simple and easily reproducible indicators to determine the two-year survival rate for a particular patient with COPD to increase the effectiveness of treatment and preventive measures.

Information sources

1. Yablonsky P.K., Alexandrova N.I., Fedorova T.A. et al. Possibilities for predicting the life expectancy of patients with COPD in order to clarify indications for lung transplantation. Pulmonology. - 2000. - No. 3. - S. 44-49.

2. Fedorova T.A., Yablonsky P.K., Bulyanitsa A.L., Alexandrova N.I. Prediction of the life expectancy of patients with severe respiratory failure for lung transplantation // Abstracts of the IX National Congress on respiratory diseases. - Moscow, 1999. - P.143.

3. Kukol L.V., Kondrashova N.M., Frisman E.Ya. Clinical and mathematical forecasting of the course of the disease in chronic obstructive bronchitis // Abstracts of the IX National Congress on respiratory diseases. - Moscow, 1999. - P.199.

Claims (1)

A method for assessing the two-year survival of patients with chronic obstructive pulmonary disease complicated by decompensated chronic pulmonary heart, including the study of anamnestic data and indicators of the cardiorespiratory system, characterized in that the partial pressure of oxygen in arterialized blood (pO ₂ ), post-bronchodilation rate of forced expiratory volume for 1 s is determined ( FEV _1), the partial pressure of carbon dioxide in blood arterializovannoy (pCO _2), right ventricular cardiac index (SI RV), Indus a smoker (IR), end-diastolic volume of the right ventricle (RV BWW), COPD exacerbations frequency solve the multiple regression equation: Survival (months) = 1.94 + 0.51 · pO ₂ (mm Hg) + 0.71 · FEV ₁ (% due) -0.52 · pCO ₂ (mm Hg) +6 , 49 · SI RV (l / min / m ² ) -0.25 · IR (packs / year) -0.12 · BWW RV (ml) -4.68 · frequency of exacerbations of COPD (“1” for exacerbations less than 3 times a year, "2" - with exacerbations of 3 or more times a year), and determine the two-year survival of patients.