Biomarkers of systemic inflammation and depression and fatigue in moderate clinically stable COPDReport as inadecuate

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Respiratory Research

, 12:3

First Online: 01 December 2011Received: 09 November 2010Accepted: 05 January 2011


IntroductionCOPD is an inflammatory disease with major co-morbidities. It has recently been suggested that depression may be the result of systemic inflammation. We aimed to explore the association between systemic inflammation and symptoms of depression and fatigue in patients with mainly moderate and clinically stable COPD using a range of inflammatory biomarkers, 2 depression and 2 fatigue scales.

MethodWe assessed 120 patients with moderate COPD FEV1% 52, men 62%, age 66. Depression was assessed using the BASDEC and CES-D scales. Fatigue was assessed using the Manchester COPD-fatigue scale MCFS and the Borg scale before and after 6MWT. We measured systemic TNF-α, CRP, TNF-α-R1, TNF-α-R2 and IL-6.

ResultsA multivariate linear model of all biomarkers showed that TNF-α only had a positive correlation with BASDEC depression score p = 0.007. TNF-α remained positively correlated with depression p = 0.024 after further adjusting for TNF-α-R1, TNF-α-R2, 6MWD, FEV1%, and pack-years. Even after adding the MCFS score, body mass and body composition to the model TNF-α was still associated with the BASDEC score p = 0.044. Furthermore, patients with higher TNF-α level > 3 pg-ml, n = 7 had higher mean CES-D depression score than the rest of the sample p = 0.03. Borg fatigue score at baseline were weakly correlated with TNF-α and CRP, and with TNF-α only after 6MWT. Patients with higher TNF-α had more fatigue after 6MWD p = 0.054.

ConclusionThis study indicates a possible association between TNF-α and two frequent and major co-morbidities in COPD; i.e., depression and fatigue.

AbbreviationsBMI Body Mass Index

BODE Multidimensional index B = Body mass index, O = Obstruction of air ways as measured by FEV1, D = Dyspnoea as measured by MRC scale, E = Exercise capacity as measured by 6MWT

BASDEC Brief Assessment Schedule Depression Cards

CES-D Centre for Epidemiologic Studies Depression Scale

COPD Chronic obstructive pulmonary disease

CRP C-reactive protein

FFMI Fat-Free Mass Index

FEV 1 Forced Expiratory Volume in 1 Second

FVC Forced Vital Capacity

GOLD Global Initiative for Chronic Obstructive Lung Disease

IL-6 Interleukin-6

IQR Interquartile range

L Litre

MRC Medical Research Council Scale

6MWD 6 Minute Walk Distance

6MWT 6 Minute Walk Test

m Meter

Q Quartile

TNF-α Tumor necrosis factor-α

TNF-α R1 Tumor necrosis factor-α receptor1

TNF-α R2 Tumor necrosis factor-α receptor2.

Electronic supplementary materialThe online version of this article doi:10.1186-1465-9921-12-3 contains supplementary material, which is available to authorized users.

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Author: Khaled Al-shair - Umme Kolsum - Rachel Dockry - Julie Morris - Dave Singh - Jørgen Vestbo


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