Combined effects of lung function, blood gases and kidney function on the exacerbation risk in stable COPD: Results from the COSYCONET cohort

F C Trudzinski; K Kahnert; C F Vogelmeier; P Alter; F Seiler; S Fähndrich; H Watz; T Welte; T Speer; S Zewinger; F Biertz; H-U Kauczor; R A Jörres; R Bals; COSYCONET consortium

doi:10.1016/j.rmed.2019.06.007

Combined effects of lung function, blood gases and kidney function on the exacerbation risk in stable COPD: Results from the COSYCONET cohort

Respir Med. 2019 Jul-Aug:154:18-26. doi: 10.1016/j.rmed.2019.06.007. Epub 2019 Jun 11.

Authors

F C Trudzinski¹, K Kahnert², C F Vogelmeier³, P Alter³, F Seiler⁴, S Fähndrich⁵, H Watz⁶, T Welte⁷, T Speer⁸, S Zewinger⁸, F Biertz⁹, H-U Kauczor¹⁰, R A Jörres¹¹, R Bals⁴; COSYCONET consortium

Collaborators

COSYCONET consortium:
Andreas Stefan¹², Bals Robert¹³, Behr Jürgen¹⁴, Kahnert Kathrin¹⁴, Bewig Burkhard¹⁵, Buhl Roland¹⁶, Ewert Ralf¹⁷, Stubbe Beate¹⁷, Ficker Joachim H¹⁸, Gogol Manfred¹⁹, Grohé Christian²⁰, Hauck Rainer²¹, Held Matthias²², Jany Berthold²², Henke Markus²³, Herth Felix²⁴, Höffken Gerd²⁵, Katus Hugo A²⁶, Kirsten Anne-Marie²⁷, Watz Henrik²⁷, Koczulla Rembert²⁸, Kenn Klaus²⁸, Kronsbein Juliane²⁹, Kropf-Sanchen Cornelia³⁰, Lange Christoph³¹, Zabel Peter³¹, Pfeifer Michael³², Randerath Winfried J³³, Eeger Werner³⁴, Studnicka Michael³⁵, Taube Christian³⁶, Teschler Helmut³⁶, Timmermann Hartmut³⁷, Virchow J Christian³⁸, Vogelmeier Claus³⁹, Wagner Ulrich⁴⁰, Welte Tobias⁴¹, Wirtz Hubert⁴²

Affiliations

¹ Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany. Electronic address: [email protected].
² Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Munich, Germany.
³ Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany.
⁴ Department of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany.
⁵ Department of Pneumology, University Hospital Freiburg, Freiburg, Germany.
⁶ Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany.
⁷ Clinic for Pneumology, Hannover Medical School, Member of the German Center for Lung Research, Hannover, Germany.
⁸ Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany.
⁹ Institute for Biostatistics, Hannover Medical School, Hannover, Germany.
¹⁰ Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Member of the German Center of Lung Research, Heidelberg, Germany.
¹¹ Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University (LMU), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
¹² Lungenfachklinik, Immenhausen, Germany.
¹³ Universitätsklinikum des Saarlandes, Germany.
¹⁴ Klinikum der Ludwig, Maximilians-Universität München, Germany.
¹⁵ Universitätsklinikum Schleswig Holstein, Germany.
¹⁶ Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Germany.
¹⁷ Universitätsmedizin Greifswald, Germany.
¹⁸ Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Germany.
¹⁹ Institut für Gerontologie, Universität Heidelberg, Germany.
²⁰ Ev. Lungenklinik Berlin, Germany.
²¹ Kliniken Südostbayern AG, Kreisklinik Bad Reichenhall, Germany.
²² Klinikum Würzburg Mitte gGmbH, Standort Missioklinik, Germany.
²³ Asklepios Fachkliniken München-Gauting, Germany.
²⁴ Thoraxklinik Heidelberg gGmbH, Germany.
²⁵ Fachkrankenhaus Coswig GmbH, Germany.
²⁶ Universitätsklinikum Heidelberg, Germany.
²⁷ Pneumologisches Forschungsinstitut an der Lungenclinic Grosshansdorf GmbH, Germany.
²⁸ Schön Klinik Berchtesgadener Land, Germany.
²⁹ Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany.
³⁰ Universitätsklinikum Ulm, Germany.
³¹ Orschungszentrum Borstel, Germany.
³² Klinik Donaustauf, Germany.
³³ Wissenschaftliches Institut Bethanien e. V., Solingen, Germany.
³⁴ Justus-Liebig-Universität Gießen, Germany.
³⁵ Uniklinikum Salzburg, Germany.
³⁶ Ruhrlandklinik gGmbH Essen, Germany.
³⁷ Hamburger Institut für Therapieforschung GmbH, Germany.
³⁸ Universitätsklinikum Rostock, Germany.
³⁹ Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Germany.
⁴⁰ Klinik Löwenstein gGmbH, Germany.
⁴¹ Medizinische Hochschule Hannover, Germany.
⁴² Universitätsklinikum Leipzig, Germany.

PMID: 31203096
DOI: 10.1016/j.rmed.2019.06.007

Abstract

Rationale: Alterations of acid-base metabolism are an important outcome predictor in acute exacerbations of COPD, whereas sufficient metabolic compensation and adequate renal function are associated with decreased mortality. In stable COPD there is, however, only limited information on the combined role of acid-base balance, blood gases, renal and respiratory function on exacerbation risk grading.

Methods: We used baseline data of the COPD cohort COSYCONET, applying linear and logistic regression analyses, the results of which were implemented into a comprehensive structural equation model. As most informative parameters it comprised the estimated glomerular filtration rate (eGFR), lung function defined via forced expiratory volume in 1 s (FEV₁), intrathoracic gas volume (ITGV) and (diffusing capacity for carbon monoxide (DLCO), moreover arterial oxygen content (CaO₂), partial pressure of oxygen (PaCO₂), base exess (BE) and exacerbation risk according to GOLD criteria. All measures were adjusted for age, gender, body-mass index, the current smoking status and pack years.

Results: 1506 patients with stable COPD (GOLD grade 1-4; mean age 64.5 ± 8.1 y; mean FEV₁ 54 ± 18 %predicted, mean eGFR 82.3 ± 16.9 mL/min/1.73 m²) were included. BE was linked to eGFR, lung function and PaCO₂ and played a role as indirect predictor of exacerbation risk via these measures; moreover, eGFR was directly linked to exacerbation risk. These associations remained significant after taking into account medication (diuretics, oral and inhaled corticosteroids), whereby corticosteroids had effects on exacerbation risk and lung function, diuretics on eGFR, BE and lung function.

Conclusion: Even in stable COPD acid-base metabolism plays a key integrative role in COPD risk assessment despite rather small deviations from normality. It partially mediates the effects of impairments in kidney function, which are also directly linked to exacerbation risk.

Keywords: Acid-base metabolism; Blood gases; COPD; Exacerbation risk; Renal function.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acid-Base Imbalance / complications*
Acid-Base Imbalance / metabolism
Aged
Blood Gas Analysis
Carbon Monoxide / metabolism
Cohort Studies
Comorbidity
Cross-Sectional Studies
Disease Progression
Female
Forced Expiratory Volume
Glomerular Filtration Rate / physiology
Humans
Kidney Function Tests
Male
Middle Aged
Partial Pressure
Pulmonary Diffusing Capacity / physiology
Pulmonary Disease, Chronic Obstructive / blood*
Pulmonary Disease, Chronic Obstructive / epidemiology
Pulmonary Disease, Chronic Obstructive / physiopathology*
Respiratory Function Tests
Risk Assessment / methods

Substances

Carbon Monoxide