Prediction Methods of Exercise Induced
Desaturation Detected by Six-minute Walk Test in Patients with Stable Chronic
Obstructive Pulmonary Disease

doi:10.12114/j.issn.1007-9572.2021.01.038

Abstract

Abstract: Background

Exercise-induced desaturation (EID) is highly prevalent, and associated with the prognosis in patients with chronic obstructive pulmonary disease (COPD) . Current predicators of EID mostly depend on pulmonary function, and the assessment for their values is different.

Objective

To explore simple, and accurate methods suitably used in primary care to predict EID by six-minute walk test (6MWT) in patients with stable COPD.

Methods

A retrospective study was conducted. Participants were 67 stable COPD patients with respiratory clinic follow-ups selected from China-Japan Friendship Hospital from 2019 to 2020. Data were collected, including assessment results of pulmonary function test, 6MWT, modified Medical Research Council (mMRC) , and COPD Assessment Test (CAT) , as well as calculated BODE index. EID in 6MWT was defined as the difference between minimum oxygen saturation in 6MWT and resting oxygen saturation at the beginning of 6MWT (ΔSpO₂) ≥4%. mMRC score, CAT score and BODE index were compared between patients with and without EID in 6MWT to estimate the association of ΔSpO₂ in 6MWT with mMRC score, CAT score and BODE index. ROC analysis was used to estimate the predictive value of mMRC score, CAT score and BODE index for inducible hypoxia in 6MWT.

Results

The ΔSpO₂ in 6MWT was significantly negatively correlated with mMRC score (r=-0.492, P<0.001) , CAT score (r=-0.447, P<0.001) , and BODE index (r=-0.415, P<0.001) . The AUC of mMRC score in predicting EID in 6MWT was 0.683 (with 2 as the optimal cut-off value) , and that for CAT score was 0.765 (with 14 as the optimal cut-off value) , for BODE index was 0.711 (with 2 as the optimal cut-off value) .

Conclusion

All of mMRC score, CAT score and BODE index can be used to predict EID in 6MWT in patients with stable COPD.

Key words: Pulmonary disease, chronic obstructive, Walk test, Hypoxia, Exercise induced desaturation, Forecasting

摘要： 背景

运动性低氧（EID）是慢性阻塞性肺疾病（COPD）患者普遍存在的问题，与COPD患者的预后有一定相关性，目前预测EID的指标多依赖肺功能且结论不一。

目的

探究适合基层医疗机构预测COPD稳定期患者六分钟步行试验（6MWT）诱导的EID的方法。

方法

本研究为回顾性研究，选择2019—2020年于中日友好医院呼吸内科门诊进行随访的COPD稳定期患者67例，同时完善了肺功能、6MWT、评估改良英国医学研究学会呼吸困难指数（mMRC）、慢性阻塞性肺病评估测试（CAT），并计算BODE指数。收集6MWT过程中最低血氧饱和度与试验开始时的静息血氧饱和度的差值（ΔSpO₂），以ΔSpO₂≥4%为EID判定标准。评估ΔSpO₂与mMRC评分、CAT评分及BODE指数的关系，绘制mMRC评分、CAT评分及BODE指数预测COPD稳定期患者发生EID的受试者工作曲线（ROC曲线）。

结果

6MWT中的ΔSpO₂与mMRC评分（r=-0.492，P<0.001）、CAT评分（r=-0.447，P<0.001）、BODE指数（r=-0.415，P<0.001）均呈负相关。mMRC评分、CAT评分及BODE指数预测COPD稳定期患者发生EID的ROC曲线下面积分别为0.683、0.765、0.711，最佳截断值分别为2分、14分、2分。

结论

mMRC评分、CAT评分及BODE指数均可作为基层医疗机构预测COPD稳定期患者发生EID的方法。

关键词: 肺疾病, 慢性阻塞性, 步行试验, 低氧, 运动性低氧, 预测

CLC Number:

R563.9

YANG Lulu, QUMU Shiwei , SITU Xuanming, HE Jiaze, YANG Ting.

Prediction Methods of Exercise Induced Desaturation Detected by Six-minute Walk Test in Patients with Stable Chronic Obstructive Pulmonary Disease [J]. Chinese General Practice, 2022, 25(02): 212-216.

杨露露,曲木诗玮,司徒炫明等. 慢性阻塞性肺疾病稳定期患者六分钟步行试验诱导的运动性低氧的预测方法研究[J]. 中国全科医学, 2022, 25(02): 212-216. DOI: 10.12114/j.issn.1007-9572.2021.01.038.

Figures/Tables 3

Table 1 Comparison of mMRC score，CAT score and BODE index between stable COPD patients with and without exercise induced desaturation by six-minute walk test

患者	例数	mMRC评分	CAT评分	BODE指数
EID	48	1.83±1.11	18.63±7.21	2.56±2.05
非EID	19	1.22±0.55	12.06±4.78	1.37±1.57
t值		2.886	4.130	2.282
P值		0.005	<0.001	0.026

Figure 1 ROC curve of mMRC score，CAT score and BODE index in predicting exercise induced desaturation by six-minute walk test in patients with stable COPD

Table 2 Value of mMRC score，CAT score and BODE index in predicting exercise induced desaturation by six-minute walk test in patients with stable COPD

指标	ROC曲线下面积	最佳截断值	灵敏度	特异度	约登指数	P值
mMRC评分	0.683	2分	0.585	0.722	0.307	0.026
CAT评分	0.765	14分	0.707	0.833	0.540	0.001
BODE指数	0.711	2分	0.902	0.444	0.346	0.010

References 31

[1]	Global Initiative for Chronic Obstructive Lung Disease（GOLD）. Global strategy for the diagnosis，management，and prevention of chronic obstructive pulmonary disease 2020 report[EB/OL]. [2020-11-01]. .
[2]	WANG C，XU J，YANG L，et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China （the China Pulmonary Health [CPH] study）：a national cross-sectional study[J]. Lancet，2018，391（10131）：1706-1717. DOI：10.1016/s0140-6736(18)30841-9.
[3]	CRISAFULLI E，IATTONI A，VENTURELLI E，et al. Predicting walking-induced oxygen desaturations in COPD patients：a statistical model[J]. Respir Care，2013，58（9）：1495-1503.
[4]	WAATEVIK M，JOHANNESSEN A，GOMEZ REAL F，et al. Oxygen desaturation in 6-Min walk test is a risk factor for adverse outcomes in COPD[J]. Eur Respir J，2016，48（1）：82-91.
[5]	CASANOVA C，COTE C，MARIN J M，et al. Distance and oxygen desaturation during the 6-Min walk test as predictors of long-term mortality in patients with COPD[J]. Chest，2008，134（4）：746-752. DOI：10.1378/chest.08-0520.
[6]	POULAIN M，DURAND F，PALOMBA B，et al. 6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD[J]. Chest，2003，123（5）：1401-1407. DOI：10.1378/chest.123.5.1401.
[7]	VAN GESTEL A J，CLARENBACH C F，STÖWHAS A C，et al. Prevalence and prediction of exercise-induced oxygen desaturation in patients with chronic obstructive pulmonary disease[J]. Respiration，2012，84（5）：353-359. DOI：10.1159/000332833.
[8]	GARCIA-TALAVERA I，TAURONI A，TRUJILLO J L，et al. Time to desaturation less than one minute predicts the need for long-term home oxygen therapy[J]. Respir Care，2011，56（11）：1812-1817. DOI：10.4187/respcare.01164.
[9]	MISU S，KANEKO M，SAKAI H，et al. Exercise-induced oxygen desaturation as a predictive factor for longitudinal decline in 6-minute walk distance in subjects with COPD[J]. Respir Care，2019，64（2）：145-152. DOI：10.4187/respcare.06169.
[10]	KAMINSKY D A，WHITMAN T，CALLAS P W. DLCO versus DLCO/VA as predictors of pulmonary gas exchange[J]. Respir Med，2007，101（5）：989-994. DOI：10.1016/j.rmed.2006.09.003.
[11]	杨露露，何佳泽，曲木诗玮，等. COPD患者6分钟步行试验诱导的运动性低氧与肺功能的关系探究[J].国际呼吸杂志，2021，41（10）：744-750. DOI：10.3760/cma.j.cn131368-20210201-00088.
[12]	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement：guidelines for the six-minute walk test[J]. Am J Respir Crit Care Med，2002，166（1）：111-117. DOI：10.1164/ajrccm.166.1.at1102.
[13]	CELLI B R，MACNEE W，FORCE A T. Standards for the diagnosis and treatment of patients with COPD：a summary of the ATS/ERS position paper[J]. Eur Respir J，2004，23（6）：932-946.
[14]	BESTALL J C，PAUL E A，GARROD R，et al. Usefulness of the Medical Research Council （MRC） dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease[J]. Thorax，1999，54（7）：581-586. DOI：10.1136/thx.54.7.581.
[15]	SMOLCIC V，PETRAK O，ROZMAN A. [COPD Assessment Test （CAT） in pulmonary rehabilitation - our experience][J]. Lijec Vjesn，2016，138（11/12）：328-335.
[16]	DODD J W，HOGG L，NOLAN J，et al. The COPD assessment test （CAT）：response to pulmonary rehabilitation. A multicentre，prospective study[J]. Thorax，2011，66（5）：425-429. DOI：10.1136/thx.2010.156372.
[17]	CELLI B R，COTE C G，MARIN J M，et al. The body-mass index，airflow obstruction，dyspnea，and exercise capacity index in chronic obstructive pulmonary disease[J]. N Engl J Med，2004，350（10）：1005-1012. DOI：10.1056/NEJMoa021322.
[18]	BALL M K，WAYPA G B，MUNGAI P T，et al. Regulation of hypoxia-induced pulmonary hypertension by vascular smooth muscle hypoxia-inducible factor-1α[J]. Am J Respir Crit Care Med，2014，189（3）：314-324. DOI：10.1164/rccm.201302-0302oc.
[19]	KENT B D，MITCHELL P D，MCNICHOLAS W T. Hypoxemia in patients with COPD：cause，effects，and disease progression[J]. Int J Chron Obstruct Pulmon Dis，2011，6：199-208.
[20]	CASANOVA C，COTE C，MARIN J M，et al. Distance and oxygen desaturation during the 6-Min walk test as predictors of long-term mortality in patients with COPD[J]. Chest，2008，134（4）：746-752. DOI：10.1378/chest.08-0520.
[21]	NATHAN S D，BARBERA J A，GAINE S P，et al. Pulmonary hypertension in chronic lung disease and hypoxia[J]. Eur Respir J，2019，53（1）. DOI：10.1183/13993003.01914-2018.
[22]	ANDRIANOPOULOS V，FRANSSEN F M，PEETERS J P，et al. Exercise-induced oxygen desaturation in COPD patients without resting hypoxemia[J]. Respir Physiol Neurobiol，2014，190：40-46. DOI：10.1016/j.resp.2013.10.002.
[23]	KIM C，SEO J B，LEE S M，et al. Exertional desaturation as a predictor of rapid lung function decline in COPD[J]. Respiration，2013，86（2）：109-116. DOI：10.1159/000342891.
[24]	MISU S，KANEKO M，SAKAI H，et al. Exercise-induced oxygen desaturation as a predictive factor for longitudinal decline in 6-minute walk distance in subjects with COPD[J]. Respir Care，2019，64（2）：145-152. DOI：10.4187/respcare.06169.
[25]	SCOTT A S，BALTZMAN M A，CHAN R，et al. Oxygen desaturation during a 6 Min walk test is a sign of nocturnal hypoxemia[J]. Can Respir J，2011，18（6）：333-337. DOI：10.1155/2011/242636.
[26]	WAATEVIK M，JOHANNESSEN A，GOMEZ REAL F，et al. Oxygen desaturation in 6-Min walk test is a risk factor for adverse outcomes in COPD[J]. Eur Respir J，2016，48（1）：82-91. DOI：10.1183/13993003.00975-2015.
[27]	张小敏，杨漂羽，张玉侠，等. 慢性阻塞性肺疾病患者运动能力与生活质量的相关性研究[J]. 中国临床医学，2020，27（3）：5.
[28]	JACOBS S S，KRISHNAN J A，LEDERER D J，et al. Home oxygen therapy for adults with chronic lung disease. an official American thoracic society clinical practice guideline[J]. Am J Respir Crit Care Med，2020，202（10）：e121-141. DOI：10.1164/rccm.202009-3608st.
[29]	慢性阻塞性肺疾病评估论坛专家组. 慢性阻塞性肺疾病病情严重程度评估系统在中国应用的专家共识[J]. 中华结核和呼吸杂志，2013，36（6）：476-478. DOI：10.3760/cma.j.issn.1001-0939.2013.06.024.
[30]	李海燕，杨汀，姚反修，等. 社区慢性阻塞性肺疾病患者运动能力及预后评估方法研究[J]. 中国全科医学，2021，24（10）：1294-1297. DOI：10.12114/j.issn.1007-9572.2021.00.031.
[31]	JONES P W，BRUSSELLE G，DAL NEGRO R W，et al. Properties of the COPD assessment test in a cross-sectional European study[J]. Eur Respir J，2011，38（1）：29-35. DOI：10.1183/09031936.00177210.