Hypogammaglobulinemia and Risk of Exacerbation and Mortality in Patients with COPD

Abstract

Are M Holm,1,2 Siw L Andreassen,3 Vivi Lycke Christensen,4– 6 Johny Kongerud,1,2 Øystein Almås,7 Henrik Auråen,2 Anne H Henriksen,8 Ingeborg S Aaberge,9 Olav Klingenberg,1,10 Tone Rustøen4,6 1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 2Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; 3Department of Medicine, Drammen Hospital, Drammen, Norway; 4Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Ullevål, Oslo, Norway; 5Lovisenberg Diaconal University College, Oslo, Norway; 6Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway; 7Department of Medicine, Østfold Hospital, Kalnes, Norway; 8Department of Circulation and Medical Imaging, St. Olav’s University Hospital, Trondheim, Norway; 9Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway; 10Department of Medical Biochemistry, Oslo University Hospital, Oslo, NorwayCorrespondence: Are M HolmDepartment of Respiratory Medicine, Oslo University Hospital and University of Oslo, Nydalen, Oslo 0424, NorwayTel [phone]Fax [phone]Email [email protected]: Chronic obstructive pulmonary disease (COPD) may, in some patients, be characterized by recurring acute exacerbations. Often these exacerbations are associated with airway infections. As immunoglobulins (Ig) are important parts of the immune defence against airway infections, the aim of this study was to relate the levels of circulating immunoglobulins to clinical features in unselected patients with COPD included in a Norwegian multicenter study.Methods: Clinical and biological data, including circulating levels of immunoglobulins, were assessed in 262 prospectively included patients with COPD GOLD stage II–IV at five hospitals in south-eastern Norway. A revisit was done after one year, and survival was assessed after five years. Clinical features and survival of those with immunoglobulin levels below reference values were compared to those with normal levels.Results: In total, 11.5% of all COPD patients and 18.5% of those with GOLD stage IV had IgG concentrations below reference values. These patients were more likely to use inhaled or oral steroids, had lower BMI, and lower FEV1%. Moreover, they had significantly more COPD-related hospital admissions (2.8 vs 0.6), number of prednisolone courses (3.9 vs 1.2), and antibiotic treatments (3.7 vs 1.5) in the preceding year. Importantly, hypogammaglobulinemia was significantly associated with reduced survival in a log-rank analysis. In multivariate regression analysis, we found that the higher risk for acute exacerbations in these patients was independent of other risk factors and was associated with impaired survival.Conclusion: In conclusion, our study suggests that hypogammaglobulinemia may be involved in poor outcome in COPD and may thus be a feasible therapeutic target for interventional studies in COPD.Keywords: COPD, immunodeficiency, IGG deficiency

Keywords

• copd
• immunodeficiency
• igg deficiency