.: ORIGINAL RESEARCH
COPD and Erythropoiesis: The Relationship Between Inflammation and Serum Erythropoietin-Prospective Cohort Study
KOAH ve Eritropoez: İnflamasyon ve Serum Eritropoetin Arasındaki İlişkiProspektif Kohort Çalışması
Turkiye Klinikleri Arch Lung. 2025;24(2):19-24
doi: 10.5336/archlung.2024-106787
Article Language: EN
Full Text
ABSTRACT
Objective: In our study, we aimed to investigate how respiratory failure and inflammation affect erythropoiesis in chronic obstructive pulmonary disease. Material and Methods: The data of 44 patients who adhered to the trial protocol during both the attack and stability phases were assessed. The correlation among blood markers, pulmonary function test [forced expiratory volume in one second (FEV1)], and erythropoietin (EPO) levels was assessed in patients throughout the attack-stable period and in polycythemic-anemic individuals. Results: EPO [14.55 mIU/mL vs. 12.55 mIU/mL (p=0.048)], neutrophil to lymphocyte ratio (NLR) [3.51 vs. 3.91 (p=0.043)], and FEV1 [1,140.3 mL vs. 996.3 mL (p=0.001)] were elevated throughout the stable phase. C-reactive protein (CRP) [6.6 and 24.35 U/L (p<0.001)] was higher during the attack period. When the parameters of polycythemics in stable and attack periods were compared, hemoglobin [16.38 g/dL, 17.1 g/dL (p=0.019)] and hematocrit [48.77% and 51.61% (p=0.019)] were found to be higher in attack, while FEV1 [1,244 mL, 640 mL (p=0.001)] was found to be lower. When the parameters of anemia patients in stable and attack periods were compared, NLR [5.78 and 3.94 (p=0.025)] was found to be higher in the stable period. CRP [76.21 U/L and 22.76 U/L (p=0.031)] and EPO [45.75 mIU/mL and 19.63 mIU/mL (p=0.007)] were elevated during the attack period. Conclusion: The suppression of EPO levels during exacerbation phases in all patient groups reflects the inhibitory influence of inflammation on EPO synthesis. Although heightened erythropoiesis during the exacerbation phase mitigated FEV1 decline in anemic patients, erythrocyte production was inhibited during the stable phase owing to diminished EPO levels and persistent inflammation. In patients with polycythemia, hemoglobin and EPO levels appear to be less affected by inflammation.
Keywords: Anemia; COPD; erythropoiesis; erythropoietin; polycythemia
Objective: In our study, we aimed to investigate how respiratory failure and inflammation affect erythropoiesis in chronic obstructive pulmonary disease. Material and Methods: The data of 44 patients who adhered to the trial protocol during both the attack and stability phases were assessed. The correlation among blood markers, pulmonary function test [forced expiratory volume in one second (FEV1)], and erythropoietin (EPO) levels was assessed in patients throughout the attack-stable period and in polycythemic-anemic individuals. Results: EPO [14.55 mIU/mL vs. 12.55 mIU/mL (p=0.048)], neutrophil to lymphocyte ratio (NLR) [3.51 vs. 3.91 (p=0.043)], and FEV1 [1,140.3 mL vs. 996.3 mL (p=0.001)] were elevated throughout the stable phase. C-reactive protein (CRP) [6.6 and 24.35 U/L (p<0.001)] was higher during the attack period. When the parameters of polycythemics in stable and attack periods were compared, hemoglobin [16.38 g/dL, 17.1 g/dL (p=0.019)] and hematocrit [48.77% and 51.61% (p=0.019)] were found to be higher in attack, while FEV1 [1,244 mL, 640 mL (p=0.001)] was found to be lower. When the parameters of anemia patients in stable and attack periods were compared, NLR [5.78 and 3.94 (p=0.025)] was found to be higher in the stable period. CRP [76.21 U/L and 22.76 U/L (p=0.031)] and EPO [45.75 mIU/mL and 19.63 mIU/mL (p=0.007)] were elevated during the attack period. Conclusion: The suppression of EPO levels during exacerbation phases in all patient groups reflects the inhibitory influence of inflammation on EPO synthesis. Although heightened erythropoiesis during the exacerbation phase mitigated FEV1 decline in anemic patients, erythrocyte production was inhibited during the stable phase owing to diminished EPO levels and persistent inflammation. In patients with polycythemia, hemoglobin and EPO levels appear to be less affected by inflammation.
Keywords: Anemia; COPD; erythropoiesis; erythropoietin; polycythemia
ÖZET
Amaç: Çalışmamızda, kronik obstrüktif akciğer hastalığında solunum yetmezliği ve inflamasyonun eritropoezi nasıl etkilediğini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışma protokolüne uygun 44 hastanın atak ve stabil dönemlerindeki verileri değerlendirildi. Olgularda, atak-stabil dönem ve polisitemik-anemik olanların kan parametreleri, solunum fonksiyon testi [1. saniyedeki zorlu ekspiratuar volüm (forced expiratory volume in one second ''FEV1'')] ve eritropoetin (EPO) düzeyleri arasındaki ilişkisi değerlendirildi. Bulgular: Stabil dönemde EPO [14,55 mIU/mL ve 12,55 mIU/mL (p=0,048)], nötrofil-lenfosit oranı (NLO) [3,51 ve 3,91 (p=0,043)] ve FEV1 düzeyleri [1.140,3 mL ve 996,3 mL (p=0,001)] yüksek bulundu. C-reaktif protein (CRP) [6,6 ve 24,35 U/L (p<0,001)] atak döneminde beklenildiği üzere yüksekti. Polisitemiklerin stabil ve atak dönemlerindeki parametreleri karşılaştırıldığında hemoglobin [16,38 g/dL, 17,1 g/dL (p=0,019)], hematokrit [%48,77 ve %51,61 (p=0,019)] atakta yüksek bulunurken, FEV1 [1.244 mL, 640 mL (p=0,001)] düşük bulundu. Anemi hastalarının stabil ve atak dönemlerindeki parametreleri karşılaştırıldığında stabil döneminde NLO [5,78 ve 3,94 (p=0,025)] yüksek bulundu. Atak döneminde CRP [76,21 U/L ve 22,76 U/L (p=0,031)] ve EPO [45,75 mIU/mL, 19,63 mIU/mL (p=0,007)] yüksek bulundu. Sonuç: Alevlenme döneminde tüm hasta gruplarında EPO seviyelerinin düşük olması, inflamasyonun EPO üretimi üzerine baskılayıcı etkisini göstermektedir. Anemiklerde atak döneminde eritropoez artışı FEV1 kaybını engellerken, stabil dönemde EPO düşüklüğü ve kronik inflamasyon nedeniyle eritrosit üretimi baskılanmıştır. Polisitemi hastalarında hemoglobin ve EPO düzeylerinin, inflamasyondan daha az etkilendiği görülmektedir.
Anahtar Kelimeler: Anemi; KOAH; eritropoez; eritropoetin; polisitemi
Amaç: Çalışmamızda, kronik obstrüktif akciğer hastalığında solunum yetmezliği ve inflamasyonun eritropoezi nasıl etkilediğini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışma protokolüne uygun 44 hastanın atak ve stabil dönemlerindeki verileri değerlendirildi. Olgularda, atak-stabil dönem ve polisitemik-anemik olanların kan parametreleri, solunum fonksiyon testi [1. saniyedeki zorlu ekspiratuar volüm (forced expiratory volume in one second ''FEV1'')] ve eritropoetin (EPO) düzeyleri arasındaki ilişkisi değerlendirildi. Bulgular: Stabil dönemde EPO [14,55 mIU/mL ve 12,55 mIU/mL (p=0,048)], nötrofil-lenfosit oranı (NLO) [3,51 ve 3,91 (p=0,043)] ve FEV1 düzeyleri [1.140,3 mL ve 996,3 mL (p=0,001)] yüksek bulundu. C-reaktif protein (CRP) [6,6 ve 24,35 U/L (p<0,001)] atak döneminde beklenildiği üzere yüksekti. Polisitemiklerin stabil ve atak dönemlerindeki parametreleri karşılaştırıldığında hemoglobin [16,38 g/dL, 17,1 g/dL (p=0,019)], hematokrit [%48,77 ve %51,61 (p=0,019)] atakta yüksek bulunurken, FEV1 [1.244 mL, 640 mL (p=0,001)] düşük bulundu. Anemi hastalarının stabil ve atak dönemlerindeki parametreleri karşılaştırıldığında stabil döneminde NLO [5,78 ve 3,94 (p=0,025)] yüksek bulundu. Atak döneminde CRP [76,21 U/L ve 22,76 U/L (p=0,031)] ve EPO [45,75 mIU/mL, 19,63 mIU/mL (p=0,007)] yüksek bulundu. Sonuç: Alevlenme döneminde tüm hasta gruplarında EPO seviyelerinin düşük olması, inflamasyonun EPO üretimi üzerine baskılayıcı etkisini göstermektedir. Anemiklerde atak döneminde eritropoez artışı FEV1 kaybını engellerken, stabil dönemde EPO düşüklüğü ve kronik inflamasyon nedeniyle eritrosit üretimi baskılanmıştır. Polisitemi hastalarında hemoglobin ve EPO düzeylerinin, inflamasyondan daha az etkilendiği görülmektedir.
Anahtar Kelimeler: Anemi; KOAH; eritropoez; eritropoetin; polisitemi
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