Changes in blood hemoglobin and blood gases PaO2 and PaCO2 in severe COPD overa three-year telemonitored program of long-term oxygen treatment

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Abstract

Background

Information on the effects of long-term oxygen treatment (LTOT) on blood hemoglobin (Hb) in severe COPD are limited. The aim was to assess blood Hb values in severe COPD, and investigate the time-course of both Hb and blood gas changes during a 3-year telemetric LTOT.

Methods

A cohort of 132 severe COPD patients (94 males; 71.4 years ± 8.8 sd), newly admitted to the tele-LTOT program, was investigated. Subjects were divided according to their original blood Hb: group A: <13 g/dL; group B: ≥13 < 15 g/dL; group C: ≥ 5 < 16 g/dL; group D: ≥16 g/dL. Blood Hb (g/dL), PaO ₂ and PaCO ₂ (mmHg), SaO ₂ (%), and BMI were measured at LTOT admission (t ₀), and at least quarterly over three years (t ₁-t ₃). Wilcoxon test was used to compare t ₀ vs. t ₁ values; linear regression to assess a possible Hb-BMI relationship; ANOVA to compare changes in Hb time-courses over the 3 years.

Results

LTOT induced a systematic increase of PaO ₂, and changes were significant since the first year (from 52.1 mmHg ± 6.6sd to 65.1 mmHg ± 8.7 sd, p < 0.001). Changes in SaO ₂ were quite similar. Comparable and equally significant trends were seen in all subgroups (p < 0.001). PaCO ₂ dropped within the first year of LTOT (from 49.4 mmHg ± 9.1sd to 45.9 mmHg ±7.5 sd, p < 0.001): the t ₀-t ₁ comparison proved significant (p < 0.01) only in subgroups with the highest basal Hb, who showed a further PaCO ₂ decline over the remaining two years (p < 0.001). Hb tended to normalization during LTOT only in subgroups with basal Hb > 15 g/dl (ANOVA p < 0.001); anemic subjects (Hb < 13 g/dl) ameliorated not significantly in the same period (ANOVA = 0.5). Survival was independent of the original blood Hb. Anemia and polyglobulia are differently prevalent in COPD, the latter being the most represented in our cohort. LTOT affected both conditions, but to a different extent and according to different time-courses. The most striking Hb improvement was in polyglobulic patients in whom also PaO ₂, PaCO ₂ and SaO ₂ dramatically improved. In anemic subjects effects were smaller and slower, oxygenation being equally ameliorated by LTOT.

Conclusions

LTOT effects on Hb and PaCO ₂ are regulated by an Hb-dependent gradient which seems independent of the original impairment of blood gases and of effects on oxygenation.

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Most cited references 23

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Scarlet M Salas, Jaime Caro, Greg G. Goss … (2001)

Anemia is common in cancer patients, although the prevalence is influenced both by the type of malignancy and the choice of treatment. Individual studies have compared the survival of patients with and without anemia and have shown reduced survival times in patients with various malignancies, including carcinoma of the lung, cervix, head and neck, prostate, lymphoma, and multiple myeloma. The objective of this study was to systematically review, to summarize, and to obtain an overall estimate of the effect of anemia on survival in patients with malignant disease. A comprehensive literature review was carried out using the MEDLINE data base and reviewing the reference lists from published studies. Two hundred papers were identified. Of these, 60 papers that reported the survival of cancer patients according to either hemoglobin levels or the presence of anemia were included. Among these papers, 25% related to patients with lung carcinoma, 17% related to patients with head and neck carcinoma, 12% related to patients with multiple myeloma, 10% related to patients with prostate carcinoma, 8% related to patients with cervicouterine carcinoma, 7% related to patients with leukemia, 5% related to patients with lymphoma, and 16% related to patients with other types of malignancies. The relative risk of death increased by 19% (95% confidence interval, 10-29%) in anemic patients with lung carcinoma, by 75% (37-123%) in anemic patients with head and neck carcinoma, by 47% (21-78%) in anemic patients with prostate carcinoma, and by 67% (30-113%) in anemic patients with lymphoma. The overall estimate increase in risk was 65% (54-77%). Anemia is associated with shorter survival times for patients with lung carcinoma, cervicouterine carcinoma, head and neck carcinoma, prostate carcinoma, lymphoma, and multiple myeloma. Copyright 2001 American Cancer Society.

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To examine the association between anemia and disability, physical performance, and muscle strength in older persons. Cross-sectional. Community-dwelling older persons in the Chianti area in Italy. A total of 1,156 persons aged 65 and older participating in the InChianti Study ("Invecchiare in Chianti," i.e., Aging in the Chianti Area). Anemia was defined according to World Health Organization criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. Disability in six basic and eight instrumental activities of daily living was assessed. Physical performance was assessed using the short physical performance battery (4-m walk, balance, and chair stands), which yields a summary performance score ranging from 0 to 12 (high). Muscle strength was determined using knee extensor and handgrip strength assessments. Overall, 11.1% of the men and 11.5% of the women had anemia. After adjustment for age, sex, body mass index, Mini-Mental State Examination score, creatinine level, and presence of various comorbid conditions, anemic persons had more disabilities (1.71 vs 1.04, P=.002) and poorer performance (8.8 vs 9.6, P=.003) than persons without anemia. Anemic persons also had significantly lower knee extensor strength (14.1 vs 15.2 kg, P=.02) and lower handgrip strength (25.3 vs 27.1 kg, P=.04) than persons without anemia. Further adjustment for inflammatory markers (interleukin-6, C-reactive protein, tumor necrosis factor-alpha) did not change these associations. Anemia is associated with disability, poorer physical performance, and lower muscle strength. Further research should explore whether treating anemia has a beneficial effect on the functional status of older persons.

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Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure.

Tamara B Horwich, Gregg C. Fonarow, Michele A Hamilton … (2002)

This study aimed to evaluate the relationship between anemia and heart failure (HF) prognosis. Although it is known that chronic diseases, including HF, may be associated with anemia, the impact of hemoglobin (Hb) level on symptoms and survival in HF has not been fully defined. We analyzed a cohort of 1,061 patients with advanced HF (New York Heart Association [NYHA] functional class III or IV and left ventricular ejection fraction [LVEF] 14.8 g/dl. Mean Hb was 13.6, and values ranged from 7.1 to 19.0 g/dl. The Hb groups were similar in age, medication profile, LVEF, hypertension, diabetes, smoking status and serum sodium. Lower Hb was associated with an impaired hemodynamic profile, higher blood urea nitrogen and creatinine, and lower albumin, total cholesterol and body mass index. Patients in the lower Hb quartiles were more likely to be NYHA functional class IV (p < 0.0001) and have lower peak oxygen consumption (PKVO(2)) (p < 0.0001). Survival at one year was higher with increased Hb quartile (55.6%, 63.9%, 71.4% and 74.4% for quartiles 1, 2, 3 and 4, respectively). On multivariate analysis adjusting for known HF prognostic factors, low Hb proved to be an independent predictor of mortality (relative risk 1.131, confidence interval 1.045 to 1.224 for each decrease of 1 g/dl). In chronic HF, relatively mild degrees of anemia are associated with worsened symptoms, functional status and survival.

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Author and article information

Journal

Journal ID (nlm-ta): Multidiscip Respir Med

Journal ID (iso-abbrev): Multidiscip Respir Med

Title: Multidisciplinary Respiratory Medicine

Publisher: BioMed Central

ISSN (Print): 1828-695X

ISSN (Electronic): 2049-6958

Publication date Collection: 2012

Publication date (Electronic): 17 July 2012

Volume: 7

Issue: 1

Page: 15

Affiliations

[1 ]Department of Respiratory Diseases, ULSS22 Veneto Region, Orlandi Hospital, Via Ospedale 2, 37012, Bussolengo, VR, Italy

[2 ]National Centre of Studies of Pharmacoeconomics and Respiratory pharmacoepidemiology (CESFAR), Via Gabriele Rossetti 4, Bussolengo, Verona, Italy

Article

Publisher ID: 2049-6958-7-15

DOI: 10.1186/2049-6958-7-15

PMC ID: 3436709

PubMed ID: 22958465

SO-VID: 910ecf2d-1aa4-4a0b-ad53-3845ecd4af08

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 15 June 2012

Date accepted : 19 June 2012

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