An Investigation of the Effect of Anemia on Prognosis in Chronic Obstructive Pulmonary Disease

Abstract

Aim: The majority of healthcare facility admissions in individuals with chronic obstructive pulmonary disease (COPD) are attributable to exacerbations, known to negatively impact prognosis. This study aims to examine the relationship between anemia in COPD patients and the frequency of exacerbations, and consequently, its effect on prognosis. Material and Method: Twenty-nine anemic, 30 normocytic, and 28 polycythemic patients diagnosed with COPD were enrolled and evaluated based on their Forced Expiratory Volume in One Second (FEV1) values, symptoms, exercise ability, and number of exacerbations. At one-year follow-up appointments, the history of emergency department visits, outpatient clinic visits, intensive care admissions, and hospitalizations requiring respiratory support during the year were recorded for patients. Results: Similar to other research on anemia in COPD, the anemia seen in the current study was most typically consistent with chronic disease anemia. When the anemic group was compared with the normostemic and polycystic groups with regard to the frequency of exacerbations, both the count of emergency department visits and hospitalizations requiring intensive care were found to be statistically meaningfully higher in the anemic group compared to the non-anemics. Conclusion: The results obtained in the present study show that anemia in COPD is associated with increased hospital admissions and exacerbations. Given that increased exacerbation frequency is a known poor prognostic factor, it can be inferred that anemia, by increasing exacerbation frequency, contributes to poor prognosis.

Keywords

• Chronic obstructive pulmonary disease
• anemia
• exacerbation
• prognosis

Kaynakça

1. Celli B, Fabbri L, Criner G, et al. Definition and Nomenclature of Chronic Obstructive Pulmonary Disease: Time for Its Revision. Am J Respir Crit Care Med. 2022;206:1317-25.
2. WHO. Chronic obstructive pulmonary disease (COPD). https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) access date 15.03.2022
3. Guo P, Li R, Piao TH, et al. Pathological mechanism and targeted drugs of COPD. Int J Chron Obstruct Pulmon Dis. 2022;17:1565-75.
4. Pillai AA, Fazal S, Mukkamalla SKR, Babiker HM. Polycythemia. 2023 May 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
5. Similowski T, Agustí A, MacNee W, Schönhofer B. The potential impact of anaemia of chronic disease in COPD. Eur Respir J. 2006;27:390-6. Erratum in: Eur Respir J. 2006 May;27(5):1076.
6. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352:1011-23.
7. Xiang Y, Luo X. Extrapulmonary comorbidities associated with chronic obstructive pulmonary disease: a review. Int J Chron Obstruct Pulmon Dis. 2024;19:567-78.
8. Inoue S. Anemia and iron deficiency in chronic obstructive pulmonary disease. Respir Investig. 2023;61:485-6.

9. Cote C, Zilberberg MD, Mody SH, et al. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J. 2007;29:923-9.
10. John M, Hoernig S, Doehner W, et al. Anemia and inflammation in COPD. Chest. 2005;127:825-9.
11. Weiss G. Pathogenesis and treatment of anaemia of chronic disease. Blood Rev. 2002;16:87-96.
12. Comeche Casanova L, Echave-Sustaeta JM, García Luján R, et al. Prevalence of anaemia associated with chronic obstructive pulmonary disease. Study of associated variables. Arch Bronconeumol. 2013;49:383-7.
13. Vijayan VK. Chronic obstructive pulmonary disease. Indian J Med Res. 2013;137:251-69.
14. Harries TH, Thornton HV, Crichton S, et al. Length of stay of COPD hospital admissions between 2006 and 2010: a retrospective longitudinal study. Int J Chron Obstruct Pulmon Dis. 2015;10:603-11.
15. World Health Organization . Iron deficiency anemia. assessment, prevention, and control. A guide for programme managers. Geneva: WHO; 2001;34-5.
16. Madu AJ, Ughasoro MD. Anaemia of chronic disease: an in-depth review. Med Princ Pract. 2017;26:1-9.
17. Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54:581-6.
18. Almagro P, Calbo E, Ochoa de Echagüen A, et al. Mortality after hospitalization for COPD. Chest. 2002;121:1441-8.
19. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005-12.
20. Ong KC, Earnest A, Lu SJ. A multidimensional grading system (BODE index) as predictor of hospitalization for COPD. Chest. 2005;128:3810-6.
21. Yohannes AM, Ershler WB. Anemia in COPD: a systematic review of the prevalence, quality of life, and mortality. Respir Care. 2011;56:644-52.
22. Bolton CE, Ionescu AA, Shiels KM, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170:1286-93.
23. Guralnik JM, Eisenstaedt RS, Ferrucci L, et al. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004;104:2263-8.
24. Boutou AK, Stanopoulos I, Pitsiou GG, et al. Anemia of chronic disease in chronic obstructive pulmonary disease: a case-control study of cardiopulmonary exercise responses. Respiration. 2011;82:237-45.
25. Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest. 2002;121:1434-40.
26. Pinto-Plata VM, Cote C, Cabral H, et al. The 6-min walk distance: change over time and value as a predictor of survival in severe COPD. Eur Respir J. 2004;23:28-33.
27. Halpern MT, Zilberberg MD, Schmier JK, et al. Anemia, costs and mortality in chronic obstructive pulmonary disease. Cost Eff Resour Alloc. 2006;4:17.
28. Chambellan A, Chailleux E, Similowski T; ANTADIR Observatory Group. Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy. Chest. 2005;128:1201-8. Erratum in: Chest. 2006;129:831.
29. Global Initiative for Chronic Obstructive Lung Disease Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2020 report). https://goldcopd.org/wp-content/uploads/2019/11/GOLD-2020-REPORT-ver1.0wms.pdf access date 06.12.2019
30. Spencer S, Calverley PM, Burge PS, Jones PW. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J. 2004;23:698-702.
31. Rimal S, Das SK, Basnet A, et al. Prevalence and clinical impact of anemia in patients diagnosed with chronic obstructive pulmonary disease: a cross-sectional study. Health Sci Rep. 2023;6:e1371.