Nowadays Chronic Obstructive Pulmonary Disease (COPD) is not considered a lung specific disease: nutritional alteration, weight loss due to increased energetic expenditure, loss of muscle mass are systemic effects, correlated with the risk of hospitalization due to exacerbation (AECOPD). AECOPD, characterised by augmented indexes like C reactive protein, interleukin-6, procalcitonin and serum amyloid A (SAA), negatively influenced natural history of the illness and were found to be related to muscle dysfunction. Hypogonadism could play a pivotal role.
Our study was aimed to evaluate possible relationships among prognostic indexes of AECOPD (represented by Acute Physiology and Chronic Health Evaluation, APACHE II Score), phlogosis (SSA), evaluated by immuno-electro-chemiluminescence, and hormonal axes involved in metabolic balance, insulin like growth factor (IGF-1), testosterone (T) and its metabolites, assayed by RIA. 24 patients, aged 75±13 years, 17 males, were studied. Data were not normally distributed, thus nonparametric statistics was applied.
Descriptive analysis showed reduced values of testosterone (T) (1.85±2.28 ng/ml), free-T (0.028±0.030 ng/ml), calculated by Vermeulens formula, dihydro-T (0.18±0.19 ng/ml) and IGF-1 (91.84±74.19 ng/ml). Frequency distributions of Apache II score and SSA were calculated and, using tertile as cut off point, three categories were defined (SSA: ≤8 mg/ml, 9160 mg/ml, ≥160 mg/ml; APACHE II: ≤10, 1112; ≥12). Using this classification, an inverse correlation between SAA and T (P: 0.01), f-T (P :0.01), DHT (P :0.001) and IGF1 (P :0.05) was found. Data showed the same inverse correlation between APACHE II tertiles on one hand and T (P :0.01) and f-T (P :0.02) on the other hand. No relationship was found between hormones and arterial blood gas analysis parameters.
Even if we cannot establish a causal relationship between hypogonadism and severity of the disease, our data suggest systemic effects of AECOPD and a possible mechanism explaining wasting syndrome in our patients
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector
05 - 09 May 2012
European Society of Endocrinology