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Eur Respir J. 2018 Feb 7;51(2). pii: 1702146. doi: 10.1183/13993003.02146-2017. Print 2018 Feb.

Emphysema and extrapulmonary tissue loss in COPD: a multi-organ loss of tissue phenotype.

Author information

1
Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA bcelli@copdnet.org.
2
GSK Research and Development, King of Prussia, PA, USA.
3
GSK Research and Development, Stevenage, UK.
4
Dept of Respiratory Medicine, Odense University Hospital, and Clinical Institute, University of Southern Denmark, Odense, Denmark.
5
Translational Medicine, Manchester Academic Health Sciences Centre, University Hospital South Manchester NHS Foundation Trust, Manchester, UK.
6
GSK Research and Development, Research Triangle Park, NC, USA.
7
Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
8
Pulmonary and Critical Care Medicine Division, Baystate Medical Center, Springfield, MA, USA.
9
Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
10
CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
11
Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.

Abstract

We tested whether emphysema progression accompanies enhanced tissue loss in other body compartments in 1817 patients from the ECLIPSE chronic obstructive pulmonary disease (COPD) cohort.Clinical and selected systemic biomarker measurements were compared in subjects grouped by quantitative tomography scan emphysema quartiles using the percentage of low attenuation area (LAA%). Lowest and highest quartile patients had amino-acid metabolomic profiles. We related LAA% to 3 years decline in lung function (forced expiratory volume in 1 s (FEV1)), body mass index (BMI), fat-free mass index (FFMI) and exacerbations, hospitalisations and mortality rates.Participants with more baseline emphysema had lower FEV1, BMI and FFMI, worse functional capacity, and less cardiovascular disease but more osteoporosis. Systemic C-reactive protein and interleukin-6 levels were similar among groups, but club cell protein 16 was higher and interleukin-8, surfactant protein D and soluble receptor for advanced glycation end product were lower with more emphysema. Metabolomics differed between extreme emphysema quartiles. Patients with more emphysema had accelerated FEV1, BMI and FFMI decline and more exacerbations, hospitalisations and mortality.COPD patients with more emphysema undergo excessive loss of pulmonary and extrapulmonary tissue, which is probably related to abnormal tissue maintenance. Because of worse clinical outcomes, we propose this subgroup be named the multi-organ loss of tissue (MOLT) COPD phenotype.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00292552.

PMID:
29437944
DOI:
10.1183/13993003.02146-2017
[Indexed for MEDLINE]

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