Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and associated with a significant burden of comorbidities. Although anemia is associated with adverse outcomes in COPD, its contribution to outcomes in individuals with other comorbid chronic diseases is not well understood. Objectives: This study examines the association of anemia with outcomes in a large, well-characterized COPD cohort, and attempts to understand the contribution of anemia to outcomes and phenotypes in individuals with other comorbidities. Methods: Participants with COPD from SPIROMICS (the Subpopulations and Intermediate Outcome Measures in COPD Study) were analyzed in adjusted models to determine the associations of normocytic anemia with clinical outcomes, computed tomographic measures, and biomarkers. Analysis was additionally performed to understand the independence and possible interactions related to cardiac and metabolic comorbidities. Results: A total of 1,789 individuals with COPD from SPIROMICS had data on hemoglobin, and of these 7.5% (n = 135) were found to have normocytic anemia. Anemic participants were older with worse airflow obstruction, a higher proportion of them were African Americans, and they had a higher burden of cardiac and metabolic comorbidities. Anemia was strongly associated with 6-minute walk distance (b, 261.43; 95% confidence interval [CI], 285.11 to 237.75), modified Medical Research Council dyspnea questionnaire (b, 0.27; 95% CI, 0.11-0.44), and St. George's Respiratory Questionnaire (b, 3.90; 95% CI, 1.09-6.71), and these adjusted associations were stronger among those with two or more cardiac and metabolic comorbidities. Anemia was associated with higher levels of serum C-reactive protein, soluble receptor for advanced glycosylation endproducts, and epithelial cadherin-1, findings that persisted when in those with a high burden of comorbidities. Conclusions: Anemia is associated with worse exercise capacity, greater dyspnea, and greater disease severity among adults with COPD, particularly among those with comorbid chronic cardiac and metabolic diseases. The biomarkers found in anemic individuals suggest inflammation, lung tissue injury, and oxidative stress as possible pathways for the adverse correlations of anemia with outcomes in COPD; however, substantial further study is required to better understand these potential mechanisms.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 710-717 |
| Number of pages | 8 |
| Journal | Annals of the American Thoracic Society |
| Volume | 15 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2018 |
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Keywords
- Anemia
- Chronic obstructive pulmonary disease
- Comorbidities
- Systemic inflammation
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
Cite this
Anemia and adverse outcomes in a chronic obstructive pulmonary disease population with a high burden of comorbidities an analysis from SPIROMICS. / on behalf of the SPIROMICS Investigators.
In: Annals of the American Thoracic Society, Vol. 15, No. 6, 01.06.2018, p. 710-717.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Anemia and adverse outcomes in a chronic obstructive pulmonary disease population with a high burden of comorbidities an analysis from SPIROMICS
AU - on behalf of the SPIROMICS Investigators
AU - Putcha, Nirupama
AU - Fawzy, Ashraf
AU - Paul, Gabriel G.
AU - Lambert, Allison A.
AU - Psoter, Kevin
AU - Sidhaye, Venkataramana
AU - Woo, John
AU - Michael Wells, J.
AU - Labaki, Wassim W.
AU - Doerschuk, Claire M.
AU - Kanner, Richard E.
AU - Han, Mei Lan K.
AU - Martinez, Carlos
AU - Paulin, Laura M.
AU - Martinez, Fernando J.
AU - Wise, Robert A
AU - O'Neal, Wanda K.
AU - Graham Barr, R.
AU - Hansel, Nadia
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Rationale: Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and associated with a significant burden of comorbidities. Although anemia is associated with adverse outcomes in COPD, its contribution to outcomes in individuals with other comorbid chronic diseases is not well understood. Objectives: This study examines the association of anemia with outcomes in a large, well-characterized COPD cohort, and attempts to understand the contribution of anemia to outcomes and phenotypes in individuals with other comorbidities. Methods: Participants with COPD from SPIROMICS (the Subpopulations and Intermediate Outcome Measures in COPD Study) were analyzed in adjusted models to determine the associations of normocytic anemia with clinical outcomes, computed tomographic measures, and biomarkers. Analysis was additionally performed to understand the independence and possible interactions related to cardiac and metabolic comorbidities. Results: A total of 1,789 individuals with COPD from SPIROMICS had data on hemoglobin, and of these 7.5% (n = 135) were found to have normocytic anemia. Anemic participants were older with worse airflow obstruction, a higher proportion of them were African Americans, and they had a higher burden of cardiac and metabolic comorbidities. Anemia was strongly associated with 6-minute walk distance (b, 261.43; 95% confidence interval [CI], 285.11 to 237.75), modified Medical Research Council dyspnea questionnaire (b, 0.27; 95% CI, 0.11-0.44), and St. George's Respiratory Questionnaire (b, 3.90; 95% CI, 1.09-6.71), and these adjusted associations were stronger among those with two or more cardiac and metabolic comorbidities. Anemia was associated with higher levels of serum C-reactive protein, soluble receptor for advanced glycosylation endproducts, and epithelial cadherin-1, findings that persisted when in those with a high burden of comorbidities. Conclusions: Anemia is associated with worse exercise capacity, greater dyspnea, and greater disease severity among adults with COPD, particularly among those with comorbid chronic cardiac and metabolic diseases. The biomarkers found in anemic individuals suggest inflammation, lung tissue injury, and oxidative stress as possible pathways for the adverse correlations of anemia with outcomes in COPD; however, substantial further study is required to better understand these potential mechanisms.
AB - Rationale: Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and associated with a significant burden of comorbidities. Although anemia is associated with adverse outcomes in COPD, its contribution to outcomes in individuals with other comorbid chronic diseases is not well understood. Objectives: This study examines the association of anemia with outcomes in a large, well-characterized COPD cohort, and attempts to understand the contribution of anemia to outcomes and phenotypes in individuals with other comorbidities. Methods: Participants with COPD from SPIROMICS (the Subpopulations and Intermediate Outcome Measures in COPD Study) were analyzed in adjusted models to determine the associations of normocytic anemia with clinical outcomes, computed tomographic measures, and biomarkers. Analysis was additionally performed to understand the independence and possible interactions related to cardiac and metabolic comorbidities. Results: A total of 1,789 individuals with COPD from SPIROMICS had data on hemoglobin, and of these 7.5% (n = 135) were found to have normocytic anemia. Anemic participants were older with worse airflow obstruction, a higher proportion of them were African Americans, and they had a higher burden of cardiac and metabolic comorbidities. Anemia was strongly associated with 6-minute walk distance (b, 261.43; 95% confidence interval [CI], 285.11 to 237.75), modified Medical Research Council dyspnea questionnaire (b, 0.27; 95% CI, 0.11-0.44), and St. George's Respiratory Questionnaire (b, 3.90; 95% CI, 1.09-6.71), and these adjusted associations were stronger among those with two or more cardiac and metabolic comorbidities. Anemia was associated with higher levels of serum C-reactive protein, soluble receptor for advanced glycosylation endproducts, and epithelial cadherin-1, findings that persisted when in those with a high burden of comorbidities. Conclusions: Anemia is associated with worse exercise capacity, greater dyspnea, and greater disease severity among adults with COPD, particularly among those with comorbid chronic cardiac and metabolic diseases. The biomarkers found in anemic individuals suggest inflammation, lung tissue injury, and oxidative stress as possible pathways for the adverse correlations of anemia with outcomes in COPD; however, substantial further study is required to better understand these potential mechanisms.
KW - Anemia
KW - Chronic obstructive pulmonary disease
KW - Comorbidities
KW - Systemic inflammation
UR - http://www.scopus.com/inward/record.url?scp=85048119521&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048119521&partnerID=8YFLogxK
U2 - 10.1513/AnnalsATS.201708-687OC
DO - 10.1513/AnnalsATS.201708-687OC
M3 - Article
C2 - 30726108
AN - SCOPUS:85048119521
VL - 15
SP - 710
EP - 717
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
SN - 2325-6621
IS - 6
ER -