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Clinical Investigations: COPD |

Prognostic Value of the Hematocrit in Patients With Severe COPD Receiving Long-term Oxygen Therapy*

Arnaud Chambellan, MD; Edmond Chailleux, MD; Thomas Similowski, MD, PhD
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Affiliations: *From the Service de Pneumologie (Dr. Chailleux) and Laboratoire des Explorations Fonctionnelles (Dr. Chambellan), CHU de Nantes, Nantes; and the Service de Pneumologie (Dr. Similowski), Groupe Hospitalier Pitié-Salpêtriere, Assistance Publique-Hôpitaux de Paris, Paris, France.,  Fédération Antadir, 66 Bd St-Michel, 75006 Paris, France.

Correspondence to: Edmond Chailleux, MD, Service de Pneumologie, CHU de Nantes, Boulevard Jacques Monod, 44093 Nantes Cedex 1, France; e-mail: edmond.chailleux@chu-nantes.fr



Chest. 2005;128(3):1201-1208. doi:10.1378/chest.128.3.1201
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Background: Although traditionally associated with polycythemia, COPD has a systemic inflammatory component that could interfere with erythropoiesis. This study describes the distribution and prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy (LTOT).

Methods: A total of 2,524 patients with COPD, FEV1/vital capacity (VC) < 70%, FEV1 < 80% of predicted, and Pao2 < 7.3 kPa in whom a hematocrit was available at entry was identified between 1980 and 1999 in the French Association Nationale pour le Traitement à Domicile de l’Insuffisance Respiratoire chronic respiratory insufficiency and home-care database (male/female ratio, 5/1; mean ± SD age, 68 ± 10 years for men, and 70 ± 10 years for women). Correlations between hematocrit, demographic data, and pulmonary function data were examined. A multivariate Cox proportional hazard regression was performed to identify prognostic factors.

Results: Mean hematocrit was 45.9 ± 7.0% in men and 43.9 ± 6.0% in women (< 39% in 12.6% of men, and < 36% in 8.2% of women) according to the World Health Organization definition of anemia. Hematocrit was negatively correlated with age (r = − 0.245) and FEV1/VC (r = − 0.068) and was positively correlated with Paco2 (r = 0.161) and body mass index (r = 0.127). Multivariate analysis found hematocrit to be an independent predictor of survival, hospital admission rate, and cumulative duration of hospitalization. The 3-year survival was 24% (95% confidence interval, 16 to 33%) when the hematocrit was < 35%, and 70% (63 to 76%) when the hematocrit was ≥ 55%.

Conclusions: A low hematocrit is not uncommon in LTOT/COPD patients. Hematocrit is negatively associated with mortality and morbidity. Whether the association is causative or not and whether or not corrective measures are warranted remain to be determined.

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