Symptom profiles and inflammatory markers in moderate to severe COPDReportar como inadecuado

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BMC Pulmonary Medicine

, 16:173

COPD and occupational lung disease


BackgroundPhysical and psychological symptoms are the hallmark of patients’ subjective perception of their illness. The purpose of this analysis was to determine if patients with COPD have distinctive symptom profiles and to examine the association of symptom profiles with systemic biomarkers of inflammation.

MethodsWe conducted latent class analyses of three physical dyspnea, fatigue, and pain and two psychological symptoms depression and anxiety in 302 patients with moderate to severe COPD using baseline data from a longitudinal observational study of depression in COPD. Systemic inflammatory markers included IL1, IL8, IL10, IL12, IL13, INF, GM-CSF, TNF-α levels >75centile was considered high; and CRP levels >3 mg-L was considered high. Multinominal logistic regression models were used to examine the association between symptom classes and inflammation while adjusting for key socio-demographic and disease characteristics.

ResultsWe found that a 4-class model best fit the data: 1 low physical and psychological symptoms 26%, Low-Phys-Low-Psych, 2 low physical but moderate psychological symptoms 18%, Low-Phys-Mod Psych, 3 high physical but moderate psychological symptoms 25%, High-Phys-Mod Psych, and 4 high physical and psychological symptoms 30%, High-Phys-High Psych. Unadjusted analyses showed associations between symptom class with high levels of IL7, IL-8 p ≤ .10 and CRP p < .01. In the adjusted model, those with a high CRP level were less likely to be in the High-Phys-Mod-Psych class compared to the Low-Phys-Low-Psych OR: 0.41, 95%CI 0.19, 0.90 and Low-Phys-Mod-Psych classes OR: 0.35, 95%CI 0.16, 0.78; elevated CRP was associated with in increased odds of being in the High-Phys-High-Psych compared to the High-Phys-Mod-Psych class OR: 2.22, 95%CI 1.08, 4.58. Younger age, having at least a college education, oxygen use and depression history were more prominent predictors of membership in the higher symptom classes.

ConclusionsPatients with COPD can be classified into four distinct symptom classes based on five commonly co-occurring physical and psychological symptoms. Systemic biomarkers of inflammation were not associated with symptom class. Additional work to test the reliability of these symptom classes, their biological drivers and their validity for prognostication and tailoring therapy in larger and more diverse samples is needed.

Trial, NCT01074515.

KeywordsCOPD Symptoms Dyspnea Fatigue Pain Depression Anxiety Inflammation AbbreviationsAICAkaike’s Information Criterion

BICBayesian Information Criterion

CASCADECOPD Activity: Serotonin Transporter, Cytokines and Depression

COPDChronic obstructive pulmonary disease

CRPHigh sensitivity C-reactive protein

CRQChronic Respiratory Questionnaire

ECLIPSEEvaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints

FEV1-FVCForced expiratory volume in one second to forced vital capacity ratio

GM-CSFGranulocyte macrophage-colony stimulating factor

High PsychHigh psychological

High-PhysHigh physical

ILInterleukin-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL12, IL13


Low-PhysLow physical

Low-PsychLow psychological

Mod PsychModerate psychological

NETTNational Emphysema Treatment Trial

SCIDStructured Clinical Interview for Depression

SOBQShortness of Breath Questionnaire

TNF-αTumor necrosis factor

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Autor: Huong Q. Nguyen - Jerald R. Herting - Kenneth C. Pike - Sina A. Gharib - Gustavo Matute-Bello - Soo Borson - Ruth Kohen


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