Levels of inflammatory mediators in chronic obstructive pulmonary disease patients with anemia of chronic disease: a case-control study

Boutou, Afroditi; Pitsiou, Georgia; Stanopoulos, Ioannis; Kontakiotis, Theodoros; Kyriazis, George; Argyropoulou, Paraskevi

doi:10.1093/qjmed/hcs024

Cited by 30 publications

(33 citation statements)

References 31 publications

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“…Once known independent predictors of worse prognosis in HF were accounted for in patients with HFrEF, IL-10 was the only inflammatory marker that remained different between patients with anemia and nonanemia (adjusted P=0.035). Similar results were observed in patients with chronic obstructive pulmonary disease, 22 where higher levels were documented in anemic patients with chronic obstructive pulmonary disease (25.6 [1.9-95.2] pg/mL) than those observed here in patients with HFrEF and anemia. Interestingly, IL-10 was recently proposed as a potential therapeutic approach to limit the progression of pressure overload-induced adverse cardiac remodeling.…”

Section: Discussionsupporting

confidence: 90%

Heart Failure With Anemia

O’Meara

Rouleau

White

et al. 2014

Circ: Heart Failure

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Background— Anemia is a highly prevalent and strong independent prognostic marker in heart failure (HF), yet this association is not completely understood. Whether anemia is simply a marker of disease severity and concomitant chronic kidney disease or represents the activation of other detrimental pathways remains uncertain. We sought to determine which pathophysiological pathways are exacerbated in patients with HF, reduced ejection fraction (HFrEF) and anemia in comparison with those without anemia. Methods and Results— In a prospective study involving 151 patients, selected biomarkers were analyzed, each representing proposed contributive mechanisms in the pathophysiology of anemia in HF. We compared clinical, echocardiographic, and circulating biomarkers profiles among patients with HFrEF and anemia (group 1), HFrEF without anemia (group 2), and chronic kidney disease with preserved EF, without established HF (chronic kidney disease control group 3). We demonstrate here that many processes other than those related to chronic kidney disease are involved in the anemia–HF relationship. These are linked to the pathophysiological mechanisms pertaining to left ventricular systolic dysfunction and remodeling, systemic inflammation and volume overload. We found that levels of interleukin-6 and interleukin-10, specific markers of cardiac remodeling (procollagen type III N-terminal peptide, matrix metalloproteinase-2, tissue inhibitor of matrix metalloproteinase 1, left atrial volume), myocardial stretch (NT-proBNP [N-terminal probrain natriuretic peptide]), and myocyte death (troponin T) are related to anemia in HFrEF. Conclusions— Anemia is strongly associated not only with markers of more advanced and active heart disease but also with the level of renal dysfunction in HFrEF. Increased myocardial remodeling, inflammation, and volume overload are the hallmarks of patients with anemia and HF. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00834691.

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Section: Discussionsupporting

confidence: 90%

Heart Failure With Anemia

O’Meara

Rouleau

White

et al. 2014

Circ: Heart Failure

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“…Anemia in patients with COPD is likely due to a combination of several factors [26,29,33]: (i) Elevated cytokines levels, especially Tumor Necrosis Factor alpha (TNF α) and interleukin-6 (IL-6) [1,12,17,18,34,35]. Moreover, persistent inflammation may be associated with poor clinical outcome for COPD patients [36].…”

Section: Discussionmentioning

confidence: 99%

Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron

et al. 2014

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BackgroundLittle is known about iron deficiency (ID) and anemia in Chronic Obstructive Pulmonary Disease (COPD). The purposes of this study were: (i) To study the prevalence and treatment of anemia and ID in patients hospitalized with an exacerbation of COPD. (ii) to study the hematological responses and degree of dyspnea before and after correction of anemia with subcutaneous Erythropoiesis Stimulating Agents (ESAs) and intravenous (IV) iron therapy, in ambulatory anemic patients with both COPD and chronic kidney disease.Methods(i) We examined the hospital records of all patients with an acute exacerbation of COPD (AECOPD) to assess the investigation, prevalence, and treatment of anemia and ID. (ii) We treated 12 anemic COPD outpatients with the combination of ESAs and IV-iron, given once weekly for 5 weeks. One week later we measured the hematological response and the severity of dyspnea by Visual Analogue Scale (VAS).Results(i) Anemia and iron deficiency in hospitalized COPD patients: Of 107 consecutive patients hospitalized with an AECOPD, 47 (43.9%) were found to be anemic on admission. Two (3.3%) of the 60 non-anemic patients and 18 (38.3%) of the 47 anemic patients had serum iron, percent transferrin saturation (%Tsat) and serum ferritin measured. All 18 (100%) anemic patients had ID, yet none had oral or IV iron subscribed before or during hospitalization, or at discharge. (ii) Intervention outpatient study: ID was found in 11 (91.7%) of the 12 anemic ambulatory patients. Hemoglobin (Hb), Hematocrit (Hct) and the VAS scale scores increased significantly with the ESAs and IV-iron treatment. There was a highly significant correlation between the ∆Hb and ∆VAS; rs = 0.71 p = 0.009 and between the ∆Hct and ∆VAS; rs = 0.8 p = 0.0014.ConclusionsID is common in COPD patients but is rarely looked for or treated. Yet correction of the ID in COPD patients with ESAs and IV iron can improve the anemia, the ID, and may improve the dyspnea.

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“…In another case-control study where ACD in COPD patients was clinically and laboratory defined, the concentration of all studied cytokines (that is TNF-α, IL-6, IL-10 and IFN-γ ) was higher in the group of anaemic compared with non-anaemic COPD patients; However, the between group differences were statistically significant only for IFN-γ and IL-10. Likewise, EPO levels were also higher in anaemic individuals, indicating the presence of EPO resistance due to systemic inflammation [70].…”

Section: Systemic Inflammation: the Link Between Copd And Acd?mentioning

confidence: 98%

Anaemia in chronic obstructive pulmonary disease: an insight into its prevalence and pathophysiology

2014

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Chronic obstructive pulmonary disease (COPD) is a major health problem, with increasing morbidity and mortality. There is a growing literature regarding the extra-pulmonary manifestations of COPD, which can have a significant impact on symptom burden and disease progression. Anaemia is one of the more recently identified co-morbidities, with a prevalence that varies between 4.9% and 38% depending on patient characteristics and the diagnostic criteria used. Systemic inflammation seems to be an important factor for its establishment and repeated bursts of inflammatory mediators during COPD exacerbations could further inhibit erythropoiesis. However, renal impairment, malnutrition, low testosterone levels, growth hormone level abnormalities, oxygen supplementation, theophylline treatment, inhibition of angiotensin-converting enzyme and aging itself are additional factors that could be associated with the development of anaemia. The present review evaluates the published literature on the prevalence and significance of anaemia in COPD. Moreover, it attempts to elucidate the reasons for the high variability reported and investigates the complex pathophysiology underlying the development of anaemia in these patients.

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Levels of inflammatory mediators in chronic obstructive pulmonary disease patients with anemia of chronic disease: a case-control study

Abstract: This study shows that in stable COPD outpatients with strictly defined ACD, levels of inflammatory mediators and erythropoietin are elevated compared to nonanemic controls.

Cited by 30 publications

References 31 publications

Heart Failure With Anemia

Heart Failure With Anemia

Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron

Anaemia in chronic obstructive pulmonary disease: an insight into its prevalence and pathophysiology

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