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Master Thesis

"Les comorbidités et traitements à visée cardiovasculaire sont les principaux facteurs prédictifs de mortalité chez les obèses hypercapniques traités à long terme par ventilation non invasive"‎ = "Comorbidities and intake of cardiovascular medications are the best predictors of mortality in patients with obesity-associated hypoventilation treated with long-term non-invasive ventilation"

Abstract : Background: The higher mortality rate in patients with obesity-associated hypoventilation is a strong rationale for long term non-invasive ventilation (NIV). The impact of co-morbidities, their medications and NIV compliance on survival of these patients remain largely unexplored. Methods: Observational cohort of hypercapnic obese initiated on NIV between March 2003 and July 2008. Anthropometric measurements, pulmonary function tests, blood gazes, nocturnal SpO2 indices, co-morbidities, medications, conditions of NIV initiation and NIV compliance from built-in counters of devices were used as covariates. Survival curves were estimated by the Kaplan-Meier method. Univariate and multivariate Cox models allowed estimating predictive factors of mortality. Results: One hundred and seven patients (56% women) in whom NIV was initiated in acute conditions in 36% 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, initiation of NIV in acute condition, use of inhaled corticosteroids, ß-blockers, non-thiazide 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. Conclusion: Cardiovascular comorbidities represent the main factor predicting mortality in NIV-treated hypercapnic obese. In this population, NIV should be used among a combination of treatment modalities allowing a reduction in cardiovascular risk.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00679903
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Submitted on : Friday, March 16, 2012 - 3:38:01 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:17 AM
Long-term archiving on: : Wednesday, December 14, 2016 - 2:48:20 PM

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  • HAL Id : dumas-00679903, version 1

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Benoît Burel. "Les comorbidités et traitements à visée cardiovasculaire sont les principaux facteurs prédictifs de mortalité chez les obèses hypercapniques traités à long terme par ventilation non invasive"‎ = "Comorbidities and intake of cardiovascular medications are the best predictors of mortality in patients with obesity-associated hypoventilation treated with long-term non-invasive ventilation". Médecine humaine et pathologie. 2012. ⟨dumas-00679903⟩

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