Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort

Background: Non-anemic iron deficiency (NAID) has been increasingly recognized as a potential factor affecting chronic obstructive pulmonary disease (COPD) outcomes. However, its prognostic role in COPD exacerbations and hospitalizations remains poorly understood. This study aimed to evaluate the pr...

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Autores: Amado Diago, Carlos Antonio, Ghadban Garrido, Cristina, Agüero Calvo, Juan, Lavín Gómez, Bernardo Alio, Martín Audera, Paula, Guerra Ruiz, Armando Raúl, Berja Miguel, Ana, Aranda, Nieves, Guzun Costachii, Anastasia, Insua López, Ana, García Unzueta, María Teresa
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universidad de Cantabria (UC)
Repositorio:UCrea Repositorio Abierto de la Universidad de Cantabria
Idioma:inglés
OAI Identifier:oai:repositorio.unican.es:10902/37902
Acceso en línea:https://hdl.handle.net/10902/37902
Access Level:acceso abierto
Palabra clave:COPD
Exacerbation
NAID
Exercise capacity
Iron
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spelling Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohortAmado Diago, Carlos AntonioGhadban Garrido, CristinaAgüero Calvo, JuanLavín Gómez, Bernardo AlioMartín Audera, PaulaGuerra Ruiz, Armando RaúlBerja Miguel, AnaAranda, NievesGuzun Costachii, AnastasiaInsua López, AnaGarcía Unzueta, María TeresaCOPDExacerbationNAIDExercise capacityIronBackground: Non-anemic iron deficiency (NAID) has been increasingly recognized as a potential factor affecting chronic obstructive pulmonary disease (COPD) outcomes. However, its prognostic role in COPD exacerbations and hospitalizations remains poorly understood. This study aimed to evaluate the prevalence of NAID in COPD patients, its impact on functional parameters, and its predictive value for exacerbations and hospitalizations. Methods: This prospective observational study included 238 patients with stable COPD and 60 age- and sex-matched smokers without COPD as a control group. NAID was defined as serum ferritin < 100 ng/mL or serum ferritin between 100 and 299 ng/mL with transferrin saturation < 20%. Clinical assessments included pulmonary function tests, 6 min walk distance (6MWD), handgrip strength, and fat-free mass index (FFMI). Patients were followed for 12 months to record moderate and severe COPD exacerbations. Cox regression analysis was used to determine the predictive value of NAID for exacerbations and hospitalizations. Results: NAID was present in 68.9% of COPD patients compared to 46.7% of smokers without COPD (p = 0.001). COPD patients with NAID had lower 6MWD (430 (330-500) m vs. 462 (390-510) m, p = 0.029), reduced FFMI (17.9 (15.5-20.2) kg/m2 vs. 20.6 (17.6-22.6) kg/m2, p < 0.001), and weaker handgrip strength (26 (22-33) kg vs. 34 (27-40) kg, p < 0.001) compared to non-NAID COPD patients. During the 12-month follow-up period, 140 patients developed moderate COPD exacerbations (107 in the NAID group), and 43 patients were hospitalized due to severe exacerbations (36 in the NAID group). Cox regression analysis showed that NAID was an independent predictor of moderate COPD exacerbations (HR 1.846, 95% CI 1.249-2.729, p = 0.002) and hospitalization (HR 2.537, 95% CI 1.129-5.703, p = 0.024) after adjusting for age, sex, lung function, and comorbidities. Conclusions: NAID is highly prevalent in COPD and is associated with worse exercise capacity, lower muscle mass, and increased exacerbation risk independently of sex and age. These findings suggest that NAID could be a valuable biomarker for risk stratification in COPD patients, warranting further research on potential therapeutic interventions targeting iron metabolism.MDPIUniversidad de Cantabria20252025-01-01journal articlehttp://purl.org/coar/resource_type/c_6501NAhttp://purl.org/coar/version/c_be7fb7dd8ff6fe43info:eu-repo/semantics/articlehttps://hdl.handle.net/10902/37902Journal of Clinical Medicine, 2025, 14(12), 4154reponame:UCrea Repositorio Abierto de la Universidad de Cantabriainstname:Universidad de Cantabria (UC)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositorio.unican.es:10902/379022026-06-02T12:39:31Z
dc.title.none.fl_str_mv Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort
title Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort
spellingShingle Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort
Amado Diago, Carlos Antonio
COPD
Exacerbation
NAID
Exercise capacity
Iron
title_short Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort
title_full Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort
title_fullStr Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort
title_full_unstemmed Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort
title_sort Non-anemic iron deficiency predicts COPD exacerbations and hospitalizations: results from a prospective cohort
dc.creator.none.fl_str_mv Amado Diago, Carlos Antonio
Ghadban Garrido, Cristina
Agüero Calvo, Juan
Lavín Gómez, Bernardo Alio
Martín Audera, Paula
Guerra Ruiz, Armando Raúl
Berja Miguel, Ana
Aranda, Nieves
Guzun Costachii, Anastasia
Insua López, Ana
García Unzueta, María Teresa
author Amado Diago, Carlos Antonio
author_facet Amado Diago, Carlos Antonio
Ghadban Garrido, Cristina
Agüero Calvo, Juan
Lavín Gómez, Bernardo Alio
Martín Audera, Paula
Guerra Ruiz, Armando Raúl
Berja Miguel, Ana
Aranda, Nieves
Guzun Costachii, Anastasia
Insua López, Ana
García Unzueta, María Teresa
author_role author
author2 Ghadban Garrido, Cristina
Agüero Calvo, Juan
Lavín Gómez, Bernardo Alio
Martín Audera, Paula
Guerra Ruiz, Armando Raúl
Berja Miguel, Ana
Aranda, Nieves
Guzun Costachii, Anastasia
Insua López, Ana
García Unzueta, María Teresa
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidad de Cantabria
dc.subject.none.fl_str_mv COPD
Exacerbation
NAID
Exercise capacity
Iron
topic COPD
Exacerbation
NAID
Exercise capacity
Iron
description Background: Non-anemic iron deficiency (NAID) has been increasingly recognized as a potential factor affecting chronic obstructive pulmonary disease (COPD) outcomes. However, its prognostic role in COPD exacerbations and hospitalizations remains poorly understood. This study aimed to evaluate the prevalence of NAID in COPD patients, its impact on functional parameters, and its predictive value for exacerbations and hospitalizations. Methods: This prospective observational study included 238 patients with stable COPD and 60 age- and sex-matched smokers without COPD as a control group. NAID was defined as serum ferritin < 100 ng/mL or serum ferritin between 100 and 299 ng/mL with transferrin saturation < 20%. Clinical assessments included pulmonary function tests, 6 min walk distance (6MWD), handgrip strength, and fat-free mass index (FFMI). Patients were followed for 12 months to record moderate and severe COPD exacerbations. Cox regression analysis was used to determine the predictive value of NAID for exacerbations and hospitalizations. Results: NAID was present in 68.9% of COPD patients compared to 46.7% of smokers without COPD (p = 0.001). COPD patients with NAID had lower 6MWD (430 (330-500) m vs. 462 (390-510) m, p = 0.029), reduced FFMI (17.9 (15.5-20.2) kg/m2 vs. 20.6 (17.6-22.6) kg/m2, p < 0.001), and weaker handgrip strength (26 (22-33) kg vs. 34 (27-40) kg, p < 0.001) compared to non-NAID COPD patients. During the 12-month follow-up period, 140 patients developed moderate COPD exacerbations (107 in the NAID group), and 43 patients were hospitalized due to severe exacerbations (36 in the NAID group). Cox regression analysis showed that NAID was an independent predictor of moderate COPD exacerbations (HR 1.846, 95% CI 1.249-2.729, p = 0.002) and hospitalization (HR 2.537, 95% CI 1.129-5.703, p = 0.024) after adjusting for age, sex, lung function, and comorbidities. Conclusions: NAID is highly prevalent in COPD and is associated with worse exercise capacity, lower muscle mass, and increased exacerbation risk independently of sex and age. These findings suggest that NAID could be a valuable biomarker for risk stratification in COPD patients, warranting further research on potential therapeutic interventions targeting iron metabolism.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025-01-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
NA
http://purl.org/coar/version/c_be7fb7dd8ff6fe43
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10902/37902
url https://hdl.handle.net/10902/37902
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv Journal of Clinical Medicine, 2025, 14(12), 4154
reponame:UCrea Repositorio Abierto de la Universidad de Cantabria
instname:Universidad de Cantabria (UC)
instname_str Universidad de Cantabria (UC)
reponame_str UCrea Repositorio Abierto de la Universidad de Cantabria
collection UCrea Repositorio Abierto de la Universidad de Cantabria
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.81155

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