• Juan P de-Torres, Denis E O'Donnell, Jose M Marín, Carlos Cabrera, Ciro Casanova, Marta Marín, Ana Ezponda, Borja G Cosio, Cristina Martinez, Ingrid Solanes, Antonia Fuster, J Alberto Neder, Jessica Gonzalez-Gutierrez, and Bartolome R Celli.
• Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada. Electronic address: jupa65@hotmail.com.
• Chest. 2021 Sep 1; 160 (3): 872-878.

BackgroundThe Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored.Research QuestionCould a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients?Study Design And MethodsGOLD stage I COPD patients (n = 360) were enrolled and followed over 109 ± 50 months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality.ResultsA Dlco cutoff value of <60% predicted was associated with all-cause mortality (Dlco ≥ 60%: 9% vs Dlco < 60%: 23%, P = .01). At a same FEV1% predicted and Charlson score, patients with Dlco < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) INTERPRETATION: In GOLD I COPD patients, a Dlco < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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