Gamma globulin fraction of the proteinogram and chronic obstructive pulmonary disease exacerbations

Boixeda, Ramón; Capdevila, J.A.; Vicente, Vanessa; Palomera, Elísabet; Juanola, Jordi; Albiach, Laia; Rex, Ainhoa; Almirall, Jordi

doi:10.1016/j.medcle.2017.06.033

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Notably, in our subgroup analysis, we found that patients with atherosclerotic heart disease and serum globulin ≥3.2 g/dL were at greater mortality risk. Moreover, it has been suggested that globulin may be a marker of severity in chronic obstructive pulmonary disease (COPD) patients, correlating with the number of readmissions after 6 months of hospitalization and forced expiratory volume in 1 sec [27]. Similarly, we also found that COPD patients with serum globulin ≥3.2 g/dL tended to have a higher all-cause mortality risk compared with non-COPD patients.…”

Section: Discussionsupporting

confidence: 66%

Association of serum globulin with all-cause mortality in incident hemodialysis patients

Pai

Kim

et al. 2021

Nephrology Dialysis Transplantation

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Background Serum globulin is a major component of total protein and can be elevated in inflammatory disease states. While inflammation is common in hemodialysis patients and associated with mortality and morbidity, the association between serum globulin and mortality have never been examined in hemodialysis patients. Methods In a retrospective cohort of 104,164 incident hemodialysis patients treated by a large dialysis organization from 2007 to 2011, we explored the association between baseline serum globulin, A/G ratio and serum protein levels and all-cause, cardiovascular and infection-related mortality with adjustments for demographic variables and laboratory markers of malnutrition and inflammation using Cox proportional hazard models. Results Patients with globulin concentration >3.8 g/dL had higher all-cause and infection-related mortality risk (Hazard Ratio [HR] 1.11, 95% Confidence Interval [95%CI]: 1.06, 1.16 and HR 1.28, 95%CI: 1.09, 1.51; respectively) in the fully adjusted model when compared to the reference group of 3.0-<3.2 g/dL. In addition, patients with A/G ratio <0.75 had a 45% higher all-cause mortality hazard (HR 1.45, 95%CI: 1.38, 1.52) and patients with total serum protein <5.5 g/dL had a 34% higher risk of death (HR: 1.34, 95%CI: 1.27, 1.42) when compared to the reference (A/G ratio 1.05-<1.15 and total serum protein 6.5-<7 g/dL, respectively). Conclusions Among incident hemodialysis patients, higher globulin level was associated with higher mortality risk independent of other markers of malnutrition and inflammation, including albumin. Lower A/G ratio and serum protein was also associated with higher mortality hazard. The mechanisms that contribute to elevated serum globulin should be further explored.

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Section: Discussionsupporting

confidence: 66%

Association of serum globulin with all-cause mortality in incident hemodialysis patients

Pai

Kim

et al. 2021

Nephrology Dialysis Transplantation

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“…Patients with lower levels of gamma globulin had more severe COPD according to GOLD criteria, the body-mass index, airflow obstruction, dyspnea, and exercise (BODE) index, and the Medical Research Council (MRC) dyspnea scale. Patients with lower gamma globulin levels had more severe reductions in FEV1 (% predicted), lower FEV1/FVC, increased requirements for home oxygen, an increased need for re-admission within 6 months, and a trend (p = 0.054) towards increased mortality within 1 year [47].…”

Section: Deficient Humoral Immunity In Copdmentioning

confidence: 98%

“…The gamma globulin fraction of serum was analyzed by protein electrophoresis in a longitudinal study of 120 patients (mean age, 72.9 years) admitted to the Hospital of Mataro, Spain for an exacerbation of COPD attributed to infectious etiology [47]. Patients with lower levels of gamma globulin had more severe COPD according to GOLD criteria, the body-mass index, airflow obstruction, dyspnea, and exercise (BODE) index, and the Medical Research Council (MRC) dyspnea scale.…”

Section: Deficient Humoral Immunity In Copdmentioning

confidence: 99%

Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease

Berger

Geng

Cameron

et al. 2017

Respiratory Medicine

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Detection of PIDD as a potentially treatable underlying contributor to recurrent/acute exacerbations and morbidity of COPD, and provision of immunoglobulin (Ig) G replacement therapy, when appropriate, may decrease the progression of COPD. Decreasing the severity and rate of exacerbations and admissions should improve the quality of life and longevity of an important subset of patients with COPD, while decreasing costs. Major steps toward achieving these goals include developing a high index of suspicion, more frequent use and appropriate interpretation of screening tests such as quantitative immunoglobulins and vaccine responses, and prompt institution of IgG replacement therapy when antibody deficiency has been diagnosed.

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Study protocol: a randomized, double-blind, parallel, two-arm, placebo control trial investigating the feasibility and safety of immunoglobulin treatment in COPD patients for prevention of frequent recurrent exacerbations

Cowan

Mulpuru

Aaron

et al. 2018

Pilot Feasibility Stud

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BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive inflammatory disease of the airways, associated with frailty, disability, co-morbidity, and mortality. Individuals with COPD experience increased risk and rates of acute exacerbation as their lung disease worsens. Current treatments to prevent acute exacerbation of COPD (AECOPD) are only modestly effective. New therapies are needed to improve the quality of life and clinical outcomes for individuals living with COPD and especially for those prone to frequent recurrent AECOPD. Recent research has suggested an association of gammaglobulin or immunoglobulin G levels with AECOPD and a favorable effect of an immunoglobulin treatment on the frequency of recurrent AECOPD, healthcare provider visits, treatments, and hospitalizations. However, control trials are required to confirm this apparent association and therapeutic effect. This study aims to assess if intravenous immunoglobulin (IVIG) therapy is feasible, safe, tolerable, and potentially effective in reducing the frequency of recurrent AECOPD.Methods/designAdult COPD patients at The Ottawa Hospital (TOH) will be recruited to partake in a randomized double-blind, parallel, two-arm, placebo control trial. Eligible patients will be administered either IVIG or normal saline following 1:1 randomization and every 4 weeks for 1 year. The primary outcome of feasibility will be determined by recruitment, patient adherence, safety and tolerance, success of the follow-up procedures, and outcome measurement. The safety and tolerability will be assessed through adverse events, adherence, and study withdrawals. Efficacy trends will be investigated by assessing incidence rates of AECOPD, improvement in quality of life, and healthcare services use and cost.DiscussionThe study results will inform larger studies designed to confirm a clinically significant therapeutic effect in identifiable populations which would be a major advance in the care of COPD patients.Trial registration numberClinicalTrial.gov, NCT03018652 and NCT02690038.Electronic supplementary materialThe online version of this article (10.1186/s40814-018-0327-z) contains supplementary material, which is available to authorized users.

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Gamma globulin fraction of the proteinogram and chronic obstructive pulmonary disease exacerbations

Cited by 3 publications

References 20 publications

Association of serum globulin with all-cause mortality in incident hemodialysis patients

Association of serum globulin with all-cause mortality in incident hemodialysis patients

Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease

Study protocol: a randomized, double-blind, parallel, two-arm, placebo control trial investigating the feasibility and safety of immunoglobulin treatment in COPD patients for prevention of frequent recurrent exacerbations

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