The opportunity COPD patients’ life-expectancy prognosing in order to elaborate indications for lung grafting

The results of 58 COPD patients’ dynamic observation (56 males and 2 females) were analysed. The patients had been treated in the State Scientific Pulmonology Centre of Health Ministry of Russian Federation and the municipal pulmonology hospital N 2 of Sankt-Peterburg city in the years 1996-1998. The patients were examined using standard clinical techniques, lung function and diffusing capacity tests, blood gas analysis, echography of pulmonary circulation. Prognostic criteria were evaluated which enable to determine the optimal date for lung grafting.
Initially all the patients were divided into two groups: 9 patients whose lifetime had not exceeded 18 months after their first examination and 49 patients who had lived more than 18 months after their first examination. The first group patients demonstrated the signs of right heart hypertrophy and overload significantly more often.
Their pulmonary artery blood pressure was increased to 38 mm Hg and the capillary blood oxygen contents was greatly diminished. Lung function and diffusing capacity parameters, pCO₂ did not differ in the groups.
Next, the certain indices’ influence on the life-expectancy as well as the prognostic value of chronic cor pulmonale existence and severity were assessed.
The correlation analysis displayed a strong tie between the COPD patients’ life-expectancy and the pulmonary artery blood pressure level, dyspnoe, heart beat rate, hypoxaemia level and also between the pulmonary artery blood pressure level and the capillary blood oxygen contents. The correlation between the severity of corpulmonale failure and the patients’ life-expectancy was faint.
The pulmonary artery blood pressure proved to be the most important parameter for the patients’ prognosis: ones having it normal lived more than 2 years meanwhile the patients with the pulmonary artery blood pressure higher 50 mm Hg lived not more 18 months. The lung functional parametbrs were not found to be the independent prognostic factors.
So, based on the result obtained the indications for lung grafting in COPD patients are thought to be the pulmonary artery blood pressure higher than 50 mm Hg, the pO₂ level less than 60 mm Hg and the conservative therapy failure.

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