Gait speed is associated with death or readmission among patients surviving acute hypercapnic respiratory failure

Gatete Karege, Dina Zekry, Gilles Allali, Dan Adler, Christophe Marti, Gatete Karege, Dina Zekry, Gilles Allali, Dan Adler, Christophe Marti

Abstract

Objectives: Death or hospital readmission are frequent among patients surviving acute hypercapnic respiratory failure (AHRF). Severity scores are not valid to predict death or readmission after AHRF. Gait speed, a simple functional parameter, has been associated with hospital admission and death in the general population. The purpose of this study is to highlight an association between gait speed at hospital discharge and death or readmission among AHRF survivors.

Design: Secondary analysis of a prospective cohort study.

Settings: Single Swiss tertiary hospital, pulmonary division.

Participants: Patients were prospectively recruited to form a cohort of patients surviving AHRF in the intensive care unit between January 2012 and May 2015.

Outcome measure: Gait speed was derived from a 6 min walking test (6MWT) before hospital discharge. All predictive variables were prospectively collected. Death or hospital readmission were recorded for 6 months. Univariate and multivariate analyses were performed to evaluate the association between predictive variables and death or hospital readmission.

Results: 71 patients performed a 6MWT. 34/71 (48%) patients died or were readmitted to the hospital during the observation period. Median gait speed was 0.7 (IQR 0.3-1.0) m/s. At 6 months, 66% (25/38) of slow walkers (gait speed <0.7 m/s) and 27% (9/33) of non-slow walkers died or were readmitted to the hospital (p=0.002). In univariate analysis, gait speed was associated with death or readmission (HR 0.41; 95% CI 0.19 to 0.90, p=0.025). In a multivariate model adjusted for age, gender, body mass index, forced expired volume, heart failure and home mechanical ventilation, gait speed remained the only variable associated with death or readmission (multivariate HR: 0.35; 95% CI 0.14 to 0.88, p=0.025).

Conclusion: This study suggests that a simple functional parameter such as gait speed is associated with death or hospital readmission in patients surviving AHRF.

Trial registration number: NCT02111876.

Keywords: exercise; non invasive ventilation; pulmonary rehabilitation.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Death or readmission during follow-up among slow and non-slow walkers.

References

    1. Brochard L, Mancebo J, Wysocki M, et al. . Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817–22. 10.1056/NEJM199509283331301
    1. Kramer N, Meyer TJ, Meharg J, et al. . Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 1995;151:1799–806. 10.1164/ajrccm.151.6.7767523
    1. Carlucci A, Delmastro M, Rubini F, et al. . Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years. Intensive Care Med 2003;29:419–25. 10.1007/s00134-002-1574-1
    1. Benhamou D, Girault C, Faure C, et al. . Nasal mask ventilation in acute respiratory failure. Experience in elderly patients. Chest 1992;102:912–7. 10.1378/chest.102.3.912
    1. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012;67:957–63. 10.1136/thoraxjnl-2011-201518
    1. Vitacca M, Clini E, Rubini F, et al. . Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: short- and long-term prognosis. Intensive Care Med 1996;22:94–100. 10.1007/BF01720714
    1. Confalonieri M, Parigi P, Scartabellati A, et al. . Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure. Eur Respir J 1996;9:422–30. 10.1183/09031936.96.09030422
    1. Chu CM, Chan VL, Lin AWN, et al. . Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure. Thorax 2004;59:1020–5. 10.1136/thx.2004.024307
    1. Almagro P, Soriano JB, Cabrera FJ, et al. . Short- and medium-term prognosis in patients hospitalized for COPD exacerbation: the CODEX index. Chest 2014;145:972–80. 10.1378/chest.13-1328
    1. Soler-Cataluña JJ, Martínez-García MA, Sánchez LS, et al. . Severe exacerbations and bode index: two independent risk factors for death in male COPD patients. Respir Med 2009;103:692–9. 10.1016/j.rmed.2008.12.005
    1. Adler D, Pépin J-L, Dupuis-Lozeron E, et al. . Comorbidities and subgroups of patients surviving severe acute hypercapnic respiratory failure in the intensive care unit. Am J Respir Crit Care Med 2017;196:200–7. 10.1164/rccm.201608-1666OC
    1. Jones SE, Maddocks M, Kon SSC, et al. . Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax 2015;70:213–8. 10.1136/thoraxjnl-2014-206440
    1. Mittal N, Raj R, Islam EA, et al. . The frequency of frailty in ambulatory patients with chronic lung diseases. J Prim Care Community Health 2016;7:10–15. 10.1177/2150131915603202
    1. Studenski S, Perera S, Patel K, et al. . Gait speed and survival in older adults. JAMA 2011;305:50–8. 10.1001/jama.2010.1923
    1. Nolan CM, Maddocks M, Maher TM, et al. . Gait speed and prognosis in patients with idiopathic pulmonary fibrosis: a prospective cohort study. Eur Respir J 2019;53. 10.1183/13993003.01186-2018
    1. Kahlon S, Pederson J, Majumdar SR, et al. . Association between frailty and 30-day outcomes after discharge from hospital. CMAJ 2015;187:799–804. 10.1503/cmaj.150100
    1. Tabata M, Shimizu R, Kamekawa D, et al. . Six-minute walk distance is an independent predictor of hospital readmission in patients with chronic heart failure. Int Heart J 2014;55:331–6. 10.1536/ihj.13-224
    1. La Rovere MT, Pinna GD, Maestri R, et al. . The 6-minute walking test and all-cause mortality in patients undergoing a post-cardiac surgery rehabilitation program. Eur J Prev Cardiol 2015;22:20–6. 10.1177/2047487313502405
    1. Kon SSC, Patel MS, Canavan JL, et al. . Reliability and validity of 4-metre gait speed in COPD. Eur Respir J 2013;42:333–40. 10.1183/09031936.00162712
    1. Kon SSC, Jones SE, Schofield SJ, et al. . Gait speed and readmission following hospitalisation for acute exacerbations of COPD: a prospective study. Thorax 2015;70:1131–7. 10.1136/thoraxjnl-2015-207046
    1. Studenski S, Perera S, Wallace D, et al. . Physical performance measures in the clinical setting. J Am Geriatr Soc 2003;51:314–22. 10.1046/j.1532-5415.2003.51104.x
    1. Cesari M, Kritchevsky SB, Penninx BWHJ, et al. . Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2005;53:1675–80. 10.1111/j.1532-5415.2005.53501.x
    1. DePew ZS, Karpman C, Novotny PJ, et al. . Correlations between gait speed, 6-minute walk distance, physical activity, and self-efficacy in patients with severe chronic lung disease. Respir Care 2013;58:2113–9. 10.4187/respcare.02471
    1. Ilgin D, Ozalevli S, Kilinc O, et al. . Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease. Ann Thorac Med 2011;6:141–6. 10.4103/1817-1737.82448
    1. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–8. 10.1111/j.1532-5415.1991.tb01616.x
    1. Morlino P, Balbi B, Guglielmetti S, et al. . Gait abnormalities of COPD are not directly related to respiratory function. Gait Posture 2017;58:352–7. 10.1016/j.gaitpost.2017.08.020
    1. Cesari M, Kritchevsky SB, Newman AB, et al. . Added value of physical performance measures in predicting adverse health-related events: results from the health, aging and body composition study. J Am Geriatr Soc 2009;57:251–9. 10.1111/j.1532-5415.2008.02126.x
    1. Bousquet J, Dinh-Xuan AT, Similowski T, et al. . Should we use gait speed in COPD, FEV1 in frailty and dyspnoea in both? Eur Respir J 2016;48:315–9. 10.1183/13993003.00633-2016
    1. Vaz Fragoso CA, Enright PL, McAvay G, et al. . Frailty and respiratory impairment in older persons. Am J Med 2012;125:79–86. 10.1016/j.amjmed.2011.06.024
    1. Valenza MC, Torres-Sánchez I, Cabrera-Martos I, et al. . Physical activity as a predictor of absence of frailty in subjects with stable COPD and COPD exacerbation. Respir Care 2016;61:212–9. 10.4187/respcare.04118
    1. European Innovation Partnership on Active and Healthy Ageing, Action Plan B3, Mechanisms of the Development of Allergy, WP 10, Global Alliance against Chronic Respiratory Diseases, et al. . Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J 2014;44:304–23. 10.1183/09031936.00014614
    1. Bousquet J, Barbara C, Bateman E, et al. . AIRWAYS-ICPs (European innovation partnership on active and healthy ageing) from concept to implementation. Eur Respir J 2016;47:1028–33. 10.1183/13993003.01856-2015
    1. Puhan MA, Gimeno-Santos E, Cates CJ, et al. . Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016;12:CD005305. 10.1002/14651858.CD005305.pub4
    1. Beauchamp MK, Evans R, Janaudis-Ferreira T, et al. . Systematic review of supervised exercise programs after pulmonary rehabilitation in individuals with COPD. Chest 2013;144:1124–33. 10.1378/chest.12-2421
    1. Richardson CR, Franklin B, Moy ML, et al. . Advances in rehabilitation for chronic diseases: improving health outcomes and function. BMJ 2019;365:l2191. 10.1136/bmj.l2191

Source: PubMed

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