To assess if dynamic hyperinflation is an independent risk factor for mortality and severe exacerbations in COPD patients. A cohort of 141 patients with stable COPD and moderate to very severe airflow limitation, treated according to conventional guidelines, was followed for a median of 9 years. Clinical characteristics were recorded and arterial blood gases, pulmonary function tests, 6-min walk and incremental exercise test with measurement of respiratory pattern and operative lung volumes were performed. Endpoints were all-cause mortality and hospitalization for COPD exacerbation. 58 patients died during the follow-up period (1228 patients x year). The mortality rate was higher in patients with dynamic hyperinflation (n = 106) than in those without it (n = 35) (14.6; 95% CI, 14.5–14.8 vs. 7.2; 95% CI, 7.1–7.4 per 1000 patients-year). After adjusting for sex, age, body mass index, pack-years and treatment with inhaled corticosteroids, dynamic hyperinflation was associated with a higher mortality risk (adjusted hazard ratio [aHR], 2.725; 95% CI, 1.010–8.161), and in a multivariate model, comorbidity, peak oxygen uptake and dynamic hyperinflation were retained as independent predictors of mortality. The time until first severe exacerbation was shorter for patients with dynamic hyperinflation (aHR, 3.961; 95% CI, 1.385–11.328), and dynamic hyperinflation, FEV and diffusing capacity were retained as independent risk factors for severe exacerbation. Moreover, patients with dynamic hyperinflation had a higher hospitalization risk than those without it (adjusted incidence rate ratio, 1.574; 95% CI, 1.087–2.581). In stable COPD patients, dynamic hyperinflation is an independent prognostic factor for mortality and severe exacerbations.

中文翻译：

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动态过度通货膨胀是 COPD 患者死亡和严重恶化的危险因素

评估动态恶性通货膨胀是否是慢性阻塞性肺病患者死亡和严重恶化的独立危险因素。对 141 名稳定期慢性阻塞性肺病 (COPD) 患者和中度至极重度气流受限患者进行的队列研究，按照常规指南进行治疗，随访时间中位数为 9 年。记录临床特征，并进行动脉血气、肺功能测试、6 分钟步行和增量运动测试，测量呼吸模式和手术肺容积。终点是全因死亡率和因慢性阻塞性肺病恶化而住院的情况。 58 名患者在随访期间死亡（1228 名患者 x 年）。患有动态过度通货膨胀的患者 (n = 106) 的死亡率高于没有动态过度通货膨胀的患者 (n = 35) (14.6; 95% CI, 14.5–14.8 vs. 7.2; 95% CI, 7.1–7.4 每 1000 名患者-年）。在调整性别、年龄、体重指数、包年数和吸入皮质类固醇治疗后，动态恶性通货膨胀与较高的死亡风险相关（调整后的风险比[aHR]，2.725；95% CI，1.010-8.161），并且在在多变量模型中，合并症、峰值摄氧量和动态恶性通货膨胀被保留作为死亡率的独立预测因素。对于动态过度充气患者，首次严重急性加重的时间较短（aHR，3.961；95% CI，1.385-11.328），动态过度充气、FEV1和弥散能力保留为严重急性加重的独立危险因素。此外，患有动态恶性通货膨胀的患者比没有动态恶性通货膨胀的患者具有更高的住院风险（调整后的发病率比，1.574；95% CI，1.087-2.581）。在稳定的慢性阻塞性肺病患者中，动态过度通货膨胀是死亡率和严重恶化的独立预后因素。