Longitudinal significance of six-minute walk test in patients with nontuberculous mycobacterial pulmonary disease: an observational study

BMC Pulmonary Medicine

Research

Naoki Hasegawa¹  Ho Namkoong¹  Tomoyasu Nishimura²  Yasunori Sato³  Koichi Fukunaga⁴  Tatsuya Kusumoto⁴  Hiromu Tanaka⁴  Masanori Kaji⁴  Atsuho Morita⁴  Genta Nagao⁴  Kazuma Yagi⁴  Ho Lee⁴  Shuhei Azekawa⁴  Shoji Suzuki⁴  Kensuke Nakagawara⁴  Satoshi Okamori⁴  Hirofumi Kamata⁴  Takunori Ogawa⁴  Takanori Asakura⁵  Yohei Funatsu⁶  Makoto Ishii⁷  Yoshifumi Kimizuka⁸ 

[1] Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan;Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan;Keio University Health Center, Tokyo, Japan;Department of Preventive Medicine and Public Health, Keio University of Medicine, Tokyo, Japan;Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan;Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan;Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan;Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan;Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan;Department of Internal Medicine, Tachikawa Hospital, Tokyo, Japan;Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan;Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan;Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan;Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan;

关键词: Nontuberculous mycobacteria;    Nontuberculous mycobacterial pulmonary disease;    Six-minute walk test;    Six-minute walk distance;    Health-related quality of life;    St. George’s respiratory questionnaire;   

DOI  :  10.1186/s12890-023-02528-y

 received in 2023-02-18, accepted in 2023-06-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe long-term exercise tolerance changes in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) are of great interest because of its chronic course. This study aimed to characterize the associations between changes over time in six-minute walking test (6MWT) parameters and clinical parameters in patients with NTM-PD.MethodsOverall, 188 patients with NTM-PD, visiting outpatient clinics at Keio University Hospital from April 2012 to March 2020 were included in the study. Data were collected using the St. George’s Respiratory Questionnaire (SGRQ), pulmonary function test (PFT), blood tests, and the 6MWT at registration and at least once after that. The association of the anchors and clinical indicators with the 6MWT parameters was assessed.ResultsThe median age [interquartile range] of the patients was 67 [63–74] years. The median baseline six-minute walk distance (6MWD) and final Borg scale (FBS) were 413 [361–470] m and 1 [0–2], respectively. In the correlation analysis, ΔSGRQ total/year (yr), Δforced vital capacity (FVC, % predicted)/yr, Δforced expiratory volume in 1 s (FEV1, % predicted)/yr, and Δdiffusing capacity for carbon monoxide (DLCO, % predicted)/yr correlated with both Δ6MWD/yr and ΔFBS/yr in the longitudinal analysis (|Rho| > 0.20). When stratified into three quantiles of changes in each anchor, the 6MWT parameters worsened over time in the bottom 25% group by mixed-effects model. Specifically, Δ6MWD was affected by SGRQ activity, SGRQ impacts, PFT (FVC, FEV1, and DLCO), and C-reactive protein (CRP). ΔFBS was affected by all SGRQ components, total score, and PFT. Anchor scores and variables at baseline that worsened Δ6MWD were higher SGRQ scores, lower FVC (% predicted), lower DLCO (% predicted), higher Krebs von den Lungen-6, old age, and undergoing treatment at registration. Similarly, these clinical parameters and elevated CRP, excluding undergoing treatment at registration, worsened ΔFBS.ConclusionsThe decreased walking distance and exacerbation of dyspnea on exertion over time in patients with NTM-PD may reflect a deterioration of health-related quality of life and pulmonary function. Thus, the change in 6MWT over time can be used as an indicator to accurately assess the patient’s condition and tailor their healthcare environment.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 2

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