Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.

<h4>Background</h4>The higher mortality rate in untreated patients with obesity-associated hypoventilation is a strong rationale for long-term noninvasive ventilation (NIV). The impacts of comorbidities, medications and NIV compliance on survival of these patients remain largely unexplor...

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Autores principales:	Jean-Christian Borel, Benoit Burel, Renaud Tamisier, Sonia Dias-Domingos, Jean-Philippe Baguet, Patrick Levy, Jean-Louis Pepin
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/94027b06930f49ddb2b72341ab7cf0a7
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spelling	oai:doaj.org-article:94027b06930f49ddb2b72341ab7cf0a72021-11-18T08:01:19ZComorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.1932-620310.1371/journal.pone.0052006https://doaj.org/article/94027b06930f49ddb2b72341ab7cf0a72013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23341888/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>The higher mortality rate in untreated patients with obesity-associated hypoventilation is a strong rationale for long-term noninvasive ventilation (NIV). The impacts of comorbidities, medications and NIV compliance on survival of these patients remain largely unexplored.<h4>Methods</h4>Observational cohort of hypercapnic obese patients initiated on NIV between March 2003 and July 2008. Survival curves were estimated by the Kaplan-Meier method. Anthropometric measurements, pulmonary function, blood gases, nocturnal SpO(2) indices, comorbidities, medications, conditions of NIV initiation and NIV compliance were used as covariates. Univariate and multivariate Cox models allowed to assess predictive factors of mortality.<h4>Results</h4>One hundred and seven patients (56% women), in whom NIV was initiated in acute (36%) or chronic conditions, were followed during 43±14 months. The 1, 2, 3 years survival rates were 99%, 94%, and 89%, respectively. In univariate analysis, death was associated with older age (>61 years), low FEV1 (<66% predicted value), male gender, BMI×time, concomitant COPD, NIV initiation in acute condition, use of inhaled corticosteroids, ß-blockers, nonthiazide diuretics, angiotensin-converting enzyme inhibitors and combination of cardiovascular drugs (one diuretic and at least one other cardiovascular agent). In multivariate analysis, combination of cardiovascular agents was the only factor independently associated with higher risk of death (HR = 5.3; 95% CI 1.18; 23.9). Female gender was associated with lower risk of death.<h4>Conclusion</h4>Cardiovascular comorbidities represent the main factor predicting mortality in patient with obesity-associated hypoventilation treated by NIV. In this population, NIV should be associated with a combination of treatment modalities to reduce cardiovascular risk.Jean-Christian BorelBenoit BurelRenaud TamisierSonia Dias-DomingosJean-Philippe BaguetPatrick LevyJean-Louis PepinPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 1, p e52006 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jean-Christian Borel Benoit Burel Renaud Tamisier Sonia Dias-Domingos Jean-Philippe Baguet Patrick Levy Jean-Louis Pepin Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.
description	<h4>Background</h4>The higher mortality rate in untreated patients with obesity-associated hypoventilation is a strong rationale for long-term noninvasive ventilation (NIV). The impacts of comorbidities, medications and NIV compliance on survival of these patients remain largely unexplored.<h4>Methods</h4>Observational cohort of hypercapnic obese patients initiated on NIV between March 2003 and July 2008. Survival curves were estimated by the Kaplan-Meier method. Anthropometric measurements, pulmonary function, blood gases, nocturnal SpO(2) indices, comorbidities, medications, conditions of NIV initiation and NIV compliance were used as covariates. Univariate and multivariate Cox models allowed to assess predictive factors of mortality.<h4>Results</h4>One hundred and seven patients (56% women), in whom NIV was initiated in acute (36%) or chronic conditions, were followed during 43±14 months. The 1, 2, 3 years survival rates were 99%, 94%, and 89%, respectively. In univariate analysis, death was associated with older age (>61 years), low FEV1 (<66% predicted value), male gender, BMI×time, concomitant COPD, NIV initiation in acute condition, use of inhaled corticosteroids, ß-blockers, nonthiazide diuretics, angiotensin-converting enzyme inhibitors and combination of cardiovascular drugs (one diuretic and at least one other cardiovascular agent). In multivariate analysis, combination of cardiovascular agents was the only factor independently associated with higher risk of death (HR = 5.3; 95% CI 1.18; 23.9). Female gender was associated with lower risk of death.<h4>Conclusion</h4>Cardiovascular comorbidities represent the main factor predicting mortality in patient with obesity-associated hypoventilation treated by NIV. In this population, NIV should be associated with a combination of treatment modalities to reduce cardiovascular risk.
format	article
author	Jean-Christian Borel Benoit Burel Renaud Tamisier Sonia Dias-Domingos Jean-Philippe Baguet Patrick Levy Jean-Louis Pepin
author_facet	Jean-Christian Borel Benoit Burel Renaud Tamisier Sonia Dias-Domingos Jean-Philippe Baguet Patrick Levy Jean-Louis Pepin
author_sort	Jean-Christian Borel
title	Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.
title_short	Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.
title_full	Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.
title_fullStr	Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.
title_full_unstemmed	Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.
title_sort	comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/94027b06930f49ddb2b72341ab7cf0a7
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Comorbidities and mortality in hypercapnic obese under domiciliary noninvasive ventilation.

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