C-reactive protein and body mass index predict outcome in end-stage respiratory failure

Chest. 2004 Aug;126(2):540-6. doi: 10.1378/chest.126.2.540.


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 à 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 corticosteroids 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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adrenal Cortex Hormones / administration & dosage
  • Aged
  • Body Mass Index*
  • C-Reactive Protein / analysis*
  • Chronic Disease
  • Cohort Studies
  • Female
  • Forced Expiratory Volume
  • Hospitalization
  • Humans
  • Male
  • Monitoring, Physiologic
  • Oxygen / analysis
  • Partial Pressure
  • Prealbumin / analysis
  • Prognosis
  • Prospective Studies
  • Respiratory Insufficiency / drug therapy
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / physiopathology*
  • Respiratory Insufficiency / therapy
  • Serum Albumin / analysis
  • Treatment Outcome
  • Ventilators, Mechanical


  • Adrenal Cortex Hormones
  • Prealbumin
  • Serum Albumin
  • C-Reactive Protein
  • Oxygen