0
Original Research: COPD |

Exertional Hypoxemia in Stable COPD Is Common and Predicted by Circulating ProadrenomedullinExertional Desaturation in COPD

Daiana Stolz, MD, MPH; Wim Boersma, MD; Francesco Blasi, MD; Renaud Louis, MD; Branislava Milenkovic, MD; Kostantinos Kostikas, MD, FCCP; Joachim G. Aerts, MD; Gernot Rohde, MD; Alicia Lacoma, PhD; Janko Rakic, MD; Lucas Boeck, MD; Paola Castellotti, MD; Andreas Scherr, MD; Alicia Marin, MD; Sabine Hertel, PhD; Sven Giersdorf, PhD; Antoni Torres, MD, FCCP; Tobias Welte, MD; Michael Tamm, MD, FCCP
Author and Funding Information

From the Department of Pneumology (Drs Stolz, Rakic, Boeck, Scherr, and Tamm), University Hospital, Basel, Switzerland; the Department of Pneumology (Dr Boersma), Medisch Centrum Alkmaar, Alkmaar, The Netherlands; the Department of Pathophysiology and Transplantation (Drs Blasi and Castellotti), University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy; the Department of Pneumology (Dr Louis), University of Liege, Liege, Belgium; the Faculty of Medicine (Dr Milenkovic), University of Belgrade and the Clinic for Pulmonary Diseases (Dr Milenkovic), Clinical Centre of Serbia, Belgrade, Serbia; the University Thessaly Medical School (Dr Kostikas), Larissa, Greece; the Erasmus MC (Dr Aerts), Rotterdam and Amphia Hospital Breda, Breda, The Netherlands; the Department of Respiratory Medicine (Dr Rohde), Maastricht University Medical Center, Maastricht, The Netherlands; the Department of Microbiology (Dr Lacoma), Hospital Universitari Germans Trias i Pujol, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona and CIBER Enfermedades Respiratorias, Badalona, Spain; the Pneumology Department (Dr Marin), Hospital Universitari Germans Trias i Pujol, Badalona, Spain; the Clinical Diagnostics Division (Drs Hertel and Giersdorf), Thermo Scientific Biomarkers, BRAHMS GmbH, Hennigsdorf, Germany; the Pneumology Department (Dr Torres), Hospital Clinic, University of Barcelona, IDIBAPS and CIBERES, Barcelona, Spain; and the Department of Pneumology (Dr Welte), Medizinische Hochschule, Hannover, Germany.

CORRESPONDENCE TO: Daiana Stolz, MD, MPH, Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; e-mail: Daiana.Stolz@usb.ch


FUNDING/SUPPORT: PROMISE-COPD was an investigator-initiated study primarily funded by the Clinic of Pulmonary Medicine and Respiratory Cell Research of the University Hospital Basel, Switzerland and by the Swiss National Foundation [Grant PP00-P3_128412/1]. Thermo Scientific Biomarkers (formerly BRAHMS AG), Hennigsdorf, Germany, provided all reagents for those analyses gratis and, through an unrestricted research grant, funded all costs of transporting blood samples to the central biomarker testing facility at University Hospital Basel.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):328-338. doi:10.1378/chest.13-1967
Text Size: A A A
Published online

BACKGROUND:  The prevalence of exertional hypoxemia in unselected patients with COPD is unknown. Intermittent hypoxia leads to adrenomedullin (ADM) upregulation through the hypoxia-inducible factor-1 pathway. We aimed to assess the prevalence and the annual probability to develop exertional hypoxemia in stable COPD. We also hypothesized that increased ADM might be associated with exertional hypoxemia and envisioned that adding ADM to clinical variables might improve its prediction in COPD.

METHODS:  A total of 1,233 6-min walk tests and circulating proadrenomedullin (proADM) levels from 574 patients with clinically stable, moderate to very severe COPD enrolled in a multinational cohort study and followed up for 2 years were concomitantly analyzed.

RESULTS:  The prevalence of exertional hypoxemia was 29.1%. In a matrix derived from a fitted-multistate model, the annual probability to develop exertional hypoxemia was 21.6%. Exertional hypoxemia was associated with greater deterioration of specific domains of health-related quality of life, higher severe exacerbation, and death annual rates. In the logistic linear and conditional Cox regression multivariable analyses, both FEV1% predicted and proADM proved independent predictors of exertional hypoxemia (P < .001 for both). Adjustment for comorbidities, including cardiovascular disorders, and exacerbation rate did not influence results. Relative to using FEV1% predicted alone, adding proADM resulted in a significant improvement of the predictive properties (P = .018). Based on the suggested nonlinear nomogram, patients with moderate COPD (FEV1% predicted = 50%) but high proADM levels (> 2 nmol/L) presented increased risk (> 30%) for exertional desaturation.

CONCLUSIONS:  Exertional desaturation is common and associated with poorer clinical outcomes in COPD. ADM improves prediction of exertional desaturation as compared with the use of FEV1% predicted alone.

TRIAL REGISTRY:  ISRCTN Register; No.: ISRCTN99586989; URL: www.controlled-trials.com

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543