Plasma apolipoprotein E level is associated with the risk of endobronchial biopsy-induced bleeding in patients with lung cancer

Abstract

Background: Factors affecting the risk of bleeding by bronchoscopic biopsy in patients with lung cancer remain unclear. The levels of plasma apolipoprotein E (ApoE) that may be associated with endobronchial biopsy (EBB)-induced bleeding have never been examined.

Methods: This was a retrospective study using data collected from 615 consecutive patients who had undergone EBB and been diagnosed with primary lung cancer from January 2014 through February 2018. Patients were either classified as the bleeding group (n = 214) or the non-bleeding group (n = 391) based on the bronchoscopy report. Multiple regression analysis was done to estimate the independent relationship between ApoE levels and EBB-induced bleeding, with an adjustment for potential confounders.

Results: The mean plasma ApoE concentration was higher in the non-bleeding group compared to that in the bleeding group (P < 0.05). However, a non-linear relationship with threshold effects was observed between plasma ApoE levels and EBB-induced bleeding in a piecewise linear regression analysis. The risk of EBB-induced bleeding decreased with ApoE concentrations from 3.5 mg/dL up to 5.9 mg/dL (adjusted odds ratio, 0.64; 95% confidence interval, 0.43-0.94); however, the incidence of EBB-induced bleeding increased with ApoE levels above the turning point (ApoE = 5.9 mg/dL).

Conclusions: There was a non-linear association between plasma ApoE levels and the risk of EBB-induced bleeding. Higher plasma ApoE concentrations (> 5.9 mg/dL) are the independent risk factor for hemorrhage during EBB in patients with lung cancer.

Keywords: Apolipoprotein E; Bleeding; Endobronchial biopsy; Lung cancer.

Fig. 1

The smooth curve fitting showed the association between the risk of EBB-induced bleeding and plasma ApoE levels after adjusting the relative confounding factors (HDLC, smoking, location of lesion, histological types, stage, and CRP), and factors considered to be clinically relevant, which include sex, age, SBP, DBP, TC, triglyceride, LDLC, diabetes, hypertension, COPD, CHD, ALT, and AST. Dotted lines represented the upper and lower 95% confidence intervals. EBB = endobronchial biopsy; ApoE = apolipoprotein E; HDLC = high density lipoprotein cholesterol; CRP = C-reactive protein; SBP = systolic blood pressure; DBP = diastolic blood pressure; TC = total cholesterol; LDLC = low density lipoprotein cholesterol; COPD = Chronic obstructive pulmonary disease; CHD = coronary heart disease; ALT = alanine aminotransferase; AST = aspartate aminotransferase