International Journal of COPD (Sep 2019)

Amino Acid-Based Metabolic Indexes Identify Patients With Chronic Obstructive Pulmonary Disease And Further Discriminates Patients In Advanced BODE Stages

  • Kuo WK,
  • Liu YC,
  • Chu CM,
  • Hua CC,
  • Huang CY,
  • Liu MH,
  • Wang CH

Journal volume & issue
Vol. Volume 14
pp. 2257 – 2266

Abstract

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Wei-Ke Kuo,1 Yu-Chih Liu,1,2 Chien-Ming Chu,1 Chung-Ching Hua,1,2 Chih-Yu Huang,1 Min-Hui Liu,2,3 Chao-Hung Wang2,3 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan; 2Chang Gung University, College of Medicine, Taoyuan, Taiwan; 3Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, TaiwanCorrespondence: Chao-Hung WangHeart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 222, Maijin Road, Anle District, Keelung City 204, TaiwanTel +886-2-24313131 ext 2245Fax +886-2-24335342Email [email protected]: The BODE index is a multidimensional grading system for predicting the prognoses of patients with chronic obstructive pulmonary disease (COPD). This study investigated whether an amino acids-based metabolic profile developed for heart failure patients (including histidine, ornithine, phenylalanine, and leucine) could identify COPD patients and further discriminates COPD patients in advanced BODE stages.Methods: Ultra-performance liquid chromatography was performed on 119 participants, including 75 COPD patients at different BODE stages and 44 normal controls. Albumin, pre-albumin, transferrin, high sensitivity C-reactive protein, and hand grip strength were also measured. Receiver operating characteristic curves and area under curves were used for estimation.Results: The BODE points in our patients were 3.29 [95% confidence interval (CI) = 2.74–3.85]. Compared to normal controls, COPD patients had lower leucine but higher ornithine levels. A COPD score, developed based on leucine and ornithine, significantly discriminated COPD from normal controls [odds ratio (OR) = 2.71, 95% CI = 1.83–4.04, p <0.001]. A COPD score of ≥ 3.00 had an OR of 15.58 (95% CI = 5.96–40.73, p <0.001). In COPD patients from BODE 1 to BODE 4, the levels of histidine, ornithine and phenylalanine increased significantly. In multivariable analysis, histidine and phenylalanine were independently able to distinguish BODE stages 3 and 4 from BODE 1 and were adopted to develop a metabolic score. Metabolic scores identified patients at BODE 3 and 4 (OR = 2.74, 95% CI =1.41–5.29, p = 0.003) better than hand grip strength, high sensitive C-reactive protein, albumin, pre-albumin, and transferrin value. A metabolic score of ≥9.53 significantly discriminated BODE 3 and 4 from BODE 1 and 2 (OR = 8.56, 95% CI = 2.77–26.39, p <0.001).Conclusion: Amino acid-based COPD score and metabolic score discriminate COPD patients from normal controls, and identify patients in advanced stages of COPD.Keywords: chronic obstructive pulmonary disease, BODE, metabolomics, amino acids, heart failure

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