Diffusing Capacity and Mortality in Chronic Obstructive Pulmonary Disease

Aparna Balasubramanian, Nirupama Putcha, Neil R. MacIntyre, Robert L. Jensen, Gregory Kinney, William W. Stringer, Craig P. Hersh, Russell P. Bowler, Richard Casaburi, Mei Lan K. Han, Janos Porszasz, R. Graham Barr, Elizabeth Regan, Barry J. Make, Nadia N. Hansel, Robert A. Wise, Meredith C. McCormack

Research output: Contribution to journalArticlepeer-review


Rationale: Chronic obstructive pulmonary disease (COPD) mortality risk is often estimated using the BODE (body mass index, obstruction, dyspnea, exercise capacity) index, including body mass index, forced expiratory volume in 1 second, dyspnea score, and 6-minute walk distance. Diffusing capacity of the lung for carbon monoxide (DlCO) is a potential predictor of mortality that reflects physiology distinct from that in the BODE index. Objectives: This study evaluated DlCO as a predictor of mortality using participants from the COPDGene study. Methods: We performed time-to-event analyses of individuals with COPD (former or current smokers with forced expiratory volume in 1 second/forced vital capacity < 0.7) and DlCO measurements from the COPDGene phase 2 visit. Cox proportional hazard methods were used to model survival, adjusting for age, sex, pack-years, smoking status, BODE index, computed tomography (CT) percent emphysema (low attenuation areas below -950 Hounsfield units), CT airway wall thickness, and history of cardiovascular or kidney diseases. C statistics for models with DlCO and BODE scores were used to compare discriminative accuracy. Results: Of 2,329 participants, 393 (16.8%) died during the follow-up period (median = 4.9 yr). In adjusted analyses, for every 10% decrease in DlCO percent predicted, mortality increased by 28% (hazard ratio = 1.28; 95% confidence interval, 1.17-1.41, P < 0.001). When compared with other clinical predictors, DlCO percent predicted performed similarly to BODE (C statistic DlCO = 0.68; BODE = 0.70), and the addition of DlCO to BODE improved its discriminative accuracy (C statistic = 0.71). Conclusions: Diffusing capacity, a measure of gas transfer, strongly predicted all-cause mortality in individuals with COPD, independent of BODE index and CT evidence of emphysema and airway wall thickness. These findings support inclusion of DlCO in prognostic models for COPD.

Original languageEnglish (US)
Pages (from-to)38-46
Number of pages9
JournalAnnals of the American Thoracic Society
Issue number1
StatePublished - Jan 1 2023


  • COPD
  • mortality
  • pulmonary diffusing capacity
  • pulmonary gas exchange

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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