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COPD and Comorbidities IV


Monday, October 22, 2007

10:30 AM - 12:00 PM

RISK FACTORS FOR COPD IN LIVER TRANSPLANT CANDIDATES

Debbie Rybak, BA*, Nadine Al-Naamani, MD, Michael J. Krowka, MD, Kari E. Roberts, MD, Raymond L. Benza, MD, David B. Badesch, MD, Roshan Shrestha, MD, James Trotter, MD, Robert S. Brown, MD, Michael B. Fallon, MD and Steven M. Kawut, MD, MS

Columbia University College of Physicians and Surgeons, New York, NY

PURPOSE: Patients with advanced liver disease commonly have a history of smoking, putting them at increased risk for COPD. However, the risk factors for COPD in this population have not been studied. We aimed to investigate the prevalence and predictors of COPD in patients with advanced liver disease who were evaluated for liver transplantation.

METHODS: We performed a prospective multicenter cohort study of patients referred for liver transplantation at seven centers in the US. We included patients who had complete pre-bronchodilator spirometry performed and smoking status determined. COPD was defined as FEV1/FVC < 0.70; severity was graded using the GOLD classification.

RESULTS: The study sample included 418 patients: the mean age was 53 ± 10 years, 62% were male, and 79% were non-Hispanic white. Liver disease was due to hepatitis C in 44%, alcohol in 41%, and NAFLD in 10%. 15% were current smokers and 40% were past smokers. 74 patients (18%, 95%CI 14-22%) had COPD; 5% mild, 10% moderate, and 3% severe. Older age, lower BMI, and any smoking were independently associated with an increased risk of COPD (p < 0.05). There was no association between MELD score and the risk of COPD. Patients with COPD had a higher alveolar-arterial oxygen gradient compared to those without COPD after adjustment for age (p = 0.02).

CONCLUSION: COPD is common among patients with advanced liver disease. Smoking history, older age, and lower BMI are risk factors in this population.

CLINICAL IMPLICATIONS: Clinicians should be aware of the prevalence of COPD in candidates for liver transplantation; screening may be useful to minimize the clinical impact in this compromised patient population.

DISCLOSURE: Debbie Rybak, No Financial Disclosure Information; No Product/Research Disclosure Information






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Copyright © 2007 by the American College of Chest Physicians.