C-Reactive Protein and Body Mass Index Predict Outcome in End-Stage Respiratory Failure* Noe ¨l J. M. Cano, MD, PhD; Claude Pichard, MD, PhD; Hubert Roth, Eng; Isabelle Court-Fortune ´, MD; Luc Cynober, PharmD, PhD; Miche `le Ge ´rard-Boncompain, MD; Antoine Cuvelier, MD, PhD; Jean-Pierre Laaban, MD, FCCP; Jean-Claude Melchior, MD; Jean-Claude Raphae ¨l, MD; Christophe M. Pison, MD, PhD; and the Clinical Research Group of the Socie ´te ´ Francophone de Nutrition Ente ´rale et Parente ´rale Study objective: To determine the predictive factors of morbidity and mortality in patients with end-stage respiratory disease. Design: Prospective, multicenter cohort study. Setting: Thirteen outpatient chest clinics within the Association Nationale de Traitement a ` Domicile de l’Insuffisance Respiratoire. Participants: Stable adult patients with chronic respiratory failure receiving long-term oxygen therapy and/or home mechanical ventilation (n  446; 182 women and 264 men; aged 68.5  12.1 years [ SD]); Respiratory diseases were COPD in 42.8%, restrictive disorders in 36.3%, mixed respiratory failure in 13.5%, and bronchiectasis in 7.4%. Recruitment was performed during the yearly examination. Patients with neuromuscular diseases and sleeping apnea were excluded. Measurements and results: Hospitalization days and survival were recorded during a follow-up of 14.3  5.6 months. Body mass index (BMI), serum albumin, and transthyretin levels were considered for their predictive value of outcome, together with demographic data, underlying respiratory disease, respiratory function, hemoglobin, C-reactive protein, smoking habits, oral corticosteroid use, and antibiotic treatment courses. Overall, 1.8  1.7 hospitalizations (cumulative stay, 17.6  27.1 days) were observed in 254 of 446 patients (57%). Independent predictors of hospitalization were oral corticosteroids, FEV 1 , and plasma C-reactive protein. One-year and 2-year cumulative survivals were 93% and 69%, respectively. Plasma C-reactive protein, BMI, PaO 2 on room air, and oral corticoste- roids independently predicted survival in multivariate analysis. Conclusion: Besides established prognosis factors such as FEV 1 and PaO 2 , nutritional depletion as assessed by BMI and overall systemic inflammation as estimated by C-reactive protein appear as major determinants of hospitalization and death risks whatever the end-stage respiratory disease. BMI and C-reactive protein should be included in the monitoring of chronic respiratory failure. Oral corticosteroids as maintenance treatment in patients with end-stage respiratory disease are an independent risk factor of death, and should be avoided in most cases. (CHEST 2004; 126:540 –546) Key words: body mass index; C-reactive protein; long-term oxygen therapy; noninvasive ventilation; survival Abbreviations: BMI = body mass index; HMV = home mechanical ventilation; LTOT = long-term oxygen therapy; NS = not significant C hronic respiratory diseases are set to become the third leading cause of death in the world. 1 In patients with end-stage respiratory disease receiving long-term oxygen therapy (LTOT) and/or home me- chanical ventilation (HMV), the median survival is approximately 3 years. 2 In face of this growing public health problem, it is of primary importance to iden- tify the determinants of survival. 2,3 Chronic respira- tory failure due to COPD is more and more regarded as a wasting disease. 3–6 In patients with COPD, whatever the stage and the type of recruitment, the impact of malnutrition on survival is established. 4,7–9 In patients receiving LTOT and/or HMV, regardless of the underlying disease, a French cooperative study 2 showed that body mass index (BMI) predicted survival. We previously reported the high prevalence of malnutrition in neuromuscular and nonneuromus- cular outpatients receiving LTOT and/or HMV. 10 540 Clinical Investigations in Critical Care Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/22013/ on 06/27/2017