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Published ahead of print on December 10, 2004, doi:10.1164/rccm.200407-867OC
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American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 591-597, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200407-867OC

Original Article

Inspiratory-to-Total Lung Capacity Ratio Predicts Mortality in Patients with Chronic Obstructive Pulmonary Disease

Ciro Casanova, Claudia Cote, Juan P. de Torres, Armando Aguirre-Jaime, Jose M. Marin, Victor Pinto-Plata and Bartolome R. Celli

Respiratory Research Institute, Hospital Universitario Nuestra Señora de Candelaria, Tenerife; and Pulmonary Department, Hospital Miguel Servet, Zaragoza, Spain; Pulmonary Department, Bay Pines Veterans Affairs Medical Center, St. Petersburg, Florida; and Pulmonary and Critical Care Department, Caritas-St. Elizabeth's Medical Center, Boston, Massachusetts

Correspondence and requests for reprints should be addressed to Ciro Casanova, M.D., Respiratory Research Institute, Hospital Universitario la Candelaria, Carretera del Rosario s/n, 38010 Santa Cruz de Tenerife, Spain. E-mail: ccasanova{at}canarias.org

Static lung hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease. We analyzed the power of lung hyperinflation as measured by the inspiratory capacity–to-total lung capacity ratio (IC/TLC) to predict mortality in a cohort of 689 patients with chronic obstructive pulmonary disease (95% males; FEV1, 1.17 L) with a mean follow-up of 34 months. We also compared the predictive value of IC/TLC with that of the BODE (body mass index, airflow obstruction, dyspnea, exercise performance) Index. Subjects who died (183; 27%) were older; had lower body mass index, FEV1, and IC/TLC ratio; walked less in the 6-minute walking distance; and had more dyspnea, a higher BODE Index, and comorbidity (p < 0.001). On the basis of logistic regression analysis, IC/TLC was found to be a good and independent predictor of all-cause and respiratory mortality. On the basis of receiver operating characteristic Type II curves, IC/TLC compared favorably with FEV1 and predicted mortality independently of the BODE Index. We conclude that IC/TLC is an independent risk factor for mortality in subjects with chronic obstructive pulmonary disease. We propose that this ratio be considered in the assessment of patients with chronic obstructive pulmonary disease.

Key Words: chronic obstructive pulmonary disease • inspiratory capacity • outcomes




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