Journal
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Volume 187, Issue 4, Pages 382-386Publisher
AMER THORACIC SOC
DOI: 10.1164/rccm.201209-1596OC
Keywords
COPD; 6MW; MCID; hospitalization; death
Categories
Funding
- NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton
- Harefield NHS Foundation Trust
- Imperial College London
- GlaxoSmithKline
- MRC [G0901786, G0901697] Funding Source: UKRI
- Medical Research Council [G0901697, G0901786] Funding Source: researchfish
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Rationale: Outcomes other than spirometry are required to assess nonbronchodilator therapies for chronic obstructive pulmonary disease. Estimates of the minimal clinically important difference for the 6-minute-walk distance (6MWD) have been derived from narrow cohorts using nonblinded intervention. Objectives: To determine minimum clinically important difference for change in 6MWD over 1 year as a function of mortality and first hospitalization in an observational cohort of patients with COPD. Methods: Data from the ECLIPSE cohort were used (n = 2,112). Death or first hospitalization were index events; we measured change in 6MWD in the 12-month period before the event and related change in 6MWD to lung function and St. George's Respiratory Questionnaire (health status). Measurement and Main Results: Of subjects with change in the 6MWD data, 94 died, and 323 were hospitalized. 6MWD fell by 29.7 m (SD, 82.9 m) more among those who died than among survivors (P < 0.001). A reduction in distance of more than 30 m conferred a hazard ratio of 1.93(95% confidence interval, 1.29-2.90; P=0.001) for death. No significant difference was observed for first hospitalization. Weak relationships only were observed with change in lung function or health status. Conclusions: A reduction in the 6MWD of 30 m or more is associated with increased risk of death but not hospitalization due to exacerbation in patients with chronic obstructive pulmonary disease and represents a clinically significant minimally important difference.
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