5 Cardiovascular diseases, diabetes mellitus, and chronic renal failure frequently coexist with COPD, and are associated independently of COPD with anemia, which aggravates prognosis. 12 While this strategy provides estimates of the prevalence and prognostic importance of hemoglobin directly ascribable to COPD, it does not reflect the importance of hemoglobin in a real-life COPD population, where most patients have numerous chronic diseases. 15 Concentrations of hemoglobin and hematocrit have been shown to provide prognostic information in different populations of COPD patients, 16 – 25 but in many of these studies patients with diseases associated with chronic anemia were excluded. Importantly, anemia might reflect iron deficiency, which has been linked to the development of pulmonary arterial hypertension 14 and presence of chronic inflammation, which is associated with frailty. Hemoglobin can potentially capture a range of prognostic factors, as homeostasis can be impaired by nutrient deficiency, comorbid disease, and medication, and is modified by tissue oxygen supply and systemic inflammation. 11 Instead, anemia might be more common, with a reported prevalence of 6.2%–46.3%. Historically, especially before the introduction of domiciliary oxygen, secondary polycythemia was a striking feature in COPD, but today the prevalence seems to be low.
Both low and high values are encountered in COPD, though the distribution varies highly with the population studied. Hemoglobin has been suggested as an easily and inexpensively measured prognostic indicator. 2 – 8 Recently developed prognostic tools take this multifaceted pathology into account by incorporating systemic as well as lung-specific parameters. Instead, COPD is a complex interplay between emphysema and airway obstruction, systemic inflammation, comorbidities, and metabolism, which all contribute to prognosis. Our understanding of COPD has evolved rapidly, and it has become clear that COPD is not an isolated disease of the lungs. 1 It is among the leading causes of mortality and morbidity worldwide, and is predicted to be the third-leading cause of death by 2020. In conclusion, low concentrations of hemoglobin are frequent in COPD patients with acute exacerbations, and predict long-term mortality.ĬOPD is a persistent, progressive airflow limitation associated with enhanced chronic inflammatory response in the airways. After discharge, compared to hemoglobin 130 g/L, the hazard ratio (HR) for males with hemoglobin 120 g/L was 1.45 (95% confidence interval 1.22–1.73), adjusted HR 1.37 (95% CI 1.15–1.64). The in-hospital mortality rates for patients with hemoglobin below or above these limits were 11.6% and 5.4%, respectively.
Hemoglobin below 130 g/L was present in 39% of males and below 120 g/L in 24% of females. Sex-specific survival analyses were fitted for different rounded concentrations of hemoglobin. Age, sex, comorbidities, medication, renal function, and concentrations of hemoglobin were retrieved. A register-based cohort of patients admitted for the first time to Danish hospitals for acute exacerbations of COPD from 2007 through 2012 was established. There is evidence of anemia as a prognostic factor in acute exacerbations, but the detailed relationship between concentrations of hemoglobin and mortality is not known. Low concentrations of hemoglobin have previously been demonstrated in many patients with COPD.
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