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. 2024 May 29;11(3):261-269.
doi: 10.15326/jcopdf.2023.0477.

COPD: Iron Deficiency and Clinical Characteristics in Patients With and Without Chronic Respiratory Failure

Ingrid Marie Hardang  1   2 , Vidar Søyseth  2   3 , Natalia Kononova  2   4 , Tor-Arne Hagve  1   2 , Gunnar Einvik  2   3
Affiliations

COPD: Iron Deficiency and Clinical Characteristics in Patients With and Without Chronic Respiratory Failure

Ingrid Marie Hardang et al. Chronic Obstr Pulm Dis. .

Abstract

Background: The prevalence of iron deficiency in patients with chronic obstructive pulmonary disease (COPD) varies in previous studies. We aimed to assess its prevalence according to 3 well-known criteria for iron deficiency, its associations with clinical characteristics of COPD, and mortality.

Methods: In a cohort study consisting of 84 COPD patients, of which 21 had chronic respiratory failure, and 59 were non-COPD controls, ferritin, transferrin saturation (TSat), and mortality across 6.5 years were assessed. Associations between clinical characteristics and iron deficiency were examined by logistic regression, while associations with mortality were assessed in mixed effects Cox regression analyses.

Results: The prevalence of iron deficiency in the study population was 10%-43% according to diagnostic criteria, and was consistently higher in individuals with COPD, peaking at 71% in participants with chronic respiratory failure. Ferritin < cutoff was significantly associated with forced expiratory volume in 1 second (FEV1) (odds ratio [OR] 0.33 per liter increase), smoking (OR 3.2), and cardiovascular disease (OR 4.7). TSat < 20% was associated with body mass index (BMI) (OR 1.1 per kg/m2 increase) and hemoglobin (OR 0.65 per g/dL increase). The combined criterion of low ferritin and TSat was only associated with FEV1 (OR 0.39 per liter increase). Mortality was not significantly associated with iron deficiency (hazard ratio [HR] 1.2-1.8).

Conclusion: The prevalence of iron deficiency in the study population increased with increasing severity of COPD. Iron deficiency, defined by ferritin < cutoff, was associated with bronchial obstruction, current smoking, and cardiovascular disease, while TSat < 20% was associated with reduced levels of hemoglobin and increased BMI. Iron deficiency was not associated with increased mortality.

Keywords: COPD; anemia; chronic respiratory failure; iron deficiency; polycythemia.

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Conflict of interest statement

GE has received unrestricted grants from Boehringer Ingelheim, Astra Zeneca, and ResMed for pulmonary research projects and has received honoraria from Astra Zeneca for expert panel discussion. All other authors have nothing to disclose.

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