Effect of Long-Term Oxygen Therapy on Survival in COPD Patients with Moderate Resting Hypoxia after Acute Exacerbation: A Propensity Score-Weighted Analysis

Abstract

<bold>Background:</bold> The impact of long-term oxygen therapy (LTOT) on survival in patients with moderate resting hypoxia remains unclear. This study evaluated the association between LTOT and overall survival in patients with a history of acute exacerbation of COPD who had moderate resting hypoxia and severe exercise hypoxemia at discharge. <bold>Methods:</bold> We conducted a retrospective cohort study of COPD patients hospitalized from 2020 to 2024, tracking survival until December 31, 2024. Patients with moderate resting hypoxia (SpO₂ 88-93%) and severe exercise hypoxemia (SpO₂ <88%) at discharge were included. To adjust for confounders, Inverse Probability of Treatment Weighting (IPTW) was applied using two analytical approaches. The complete case analysis included 15 patients, while the full sample IPTW analysis included 24 patients. <bold>Results:</bold> In the complete case analysis, LTOT was associated with a markedly lower mortality risk (HR = 1.21 × 10⁻⁸, 95% CI: 1.14 × 10⁻⁹ – 1.29 × 10⁻⁷, p < 0.001). In the full sample IPTW analysis, LTOT was associated with a higher mortality risk (HR = 3.26, 95% CI: 0.6186 – 17.22, p = 0.163). Sensitivity analyses remained inconclusive. <bold>Conclusions:</bold> The results were inconsistent, preventing a definitive conclusion on LTOT’s effect. The study is limited by baseline variability, small sample size, and residual confounding. <bold>Declaration of Generative AI and AI-assisted</bold> <bold>technologies</bold> During the preparation of this work, the authors used ChatGPT for language clarity. The final content was reviewed and edited by the authors, who take full responsibility for its accuracy.

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