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Pulmonary Vascular Disease |

Erythropoietin Levels in Patients With Interstitial Lung Disease

Kim Moi Wong Lama*, MD; Purvesh Patel, MD; Toshita Kumar, MD; Rebecca Miller, BA; Nina Kohn, MA; Arunabh Talwar, MD
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North Shore LIJ Health System, Manhasset, NY


Chest. 2012;142(4_MeetingAbstracts):846A. doi:10.1378/chest.1389986
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Abstract

SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Determine if erythropoietin (EPO) level correlates with severity of interstitial lung disease (ILD), as defined by the WHO functional class. EPO, a glycoprotein produced by the kidney, is critical for red blood cell production and is regulated by changes in oxygen availability.

METHODS: Patients with ILD alone or ILD with Pulmonary Hypertension (PH) were included. PH was defined as mean pulmonary artery pressure ≥25mmHg, and pulmonary capillary wedge pressure ≤18mmHg. The WHO functional class was determined based on symptoms reported by the patient. Analysis was performed with SAS® (version 9), Cary NC. Patients with hemoglobin <12 mg/dl or a serum creatinine >1.5mg/dl were excluded. 64 patients met criterion, 37 were female. Mean age was 63.3.

RESULTS: Mean values were an erythropoietin level of 23.68 mIU/mL (±24.89), oxygen saturation of 91.03%±7.02, creatinine of 0.93 mg/dL ±0.22, and hemoglobin level of 14.06g/dL±1.41. There was a significant difference between EPO levels in patients with lower functional classes (I and II) [Mean 19.45±18.80, Median 14.9, interquartile range 14.7; n=32] versus higher functional classes (III and IV) [Mean 30.90±33.41 Median 18.1, IQR 17.1; n= 23], {P<0.02205; Mann-Whitney Test}. PH in the setting of ILD was more common in patients with functional classes III and IV. Differences were noted between EPO levels in patients on room air [20.16 ± 22.65, Median 15.1, IQR 13.3±; n= 42] versus patients on supplemental oxygen [30.82 ± 28.64±, Median 19.0, IQR 17.8; n= 21], {P<0.04105; Mann-Whitney Test}.

CONCLUSIONS: This study confirms that serum EPO levels in patients with ILD are associated with traditional markers of severe disease like poorer functional classes (III/IV) and may be a measure of disease progression and PH development.

CLINICAL IMPLICATIONS: Transcriptional regulation as a response to hypoxia in ILD is crucial for vascular remodeling and involves several classes of signals and target genes. EPO is induced by transcription factor HIF 1 alpha (Semenza, G.L., and Wang, G.L. 1992 Mol. Cell Biol. 12:5447-5454). Its role in pulmonary vascular dysfunction in ILD patients warrants further investigation.

DISCLOSURE: The following authors have nothing to disclose: Kim Moi Wong Lama, Purvesh Patel, Toshita Kumar, Rebecca Miller, Nina Kohn, Arunabh Talwar

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North Shore LIJ Health System, Manhasset, NY

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