Low-blood lymphocyte number and lymphocyte decline as key factors in COPD outcomes: a longitudinal cohort study

Semenzato, U. ; Biondini, D. ; Bazzan, E. ; Tiné, M. ; Balestro, E. ; Buldini, B. ; Carizzo, S. J. ; Cubero, P. ; Marin-Oto, M. ; Casara, A. ; Baraldo, S. ; Turato, G. ; Gregori, D. ; Marin, J. M. (Universidad de Zaragoza) ; Cosio, M. G. ; Saetta, M.

Resumen: Background: Smokers with and without chronic obstructive pulmonary disease (COPD) are at risk of severe outcomes like exacerbations, cancer, respiratory failure, and decreased survival. The mechanisms for these outcomes are unclear; however, there is evidence that blood lymphocytes (BL) number might play a role. Objective: The objective of this study is to investigate the relationship between BL and their possible decline over time with long-term outcomes in smokers with and without COPD. Methods: In 511 smokers, 302 with COPD (COPD) and 209 without COPD (noCOPD), followed long term, we investigated whether BL number and BL decline over time might be associated with long-term outcomes. Smokers were divided according to BL number in high-BL (=1, 800 cells/µL) and low-BL (<1, 800 cells/µL). Clinical features, cancer incidence, and mortality were recorded during follow-up. BL count in multiple samples and BL decline over time were calculated and related to outcomes. Results: BL count was lower in COPD (1, 880 cells/µL) than noCOPD (2, 300 cells/µL; p < 0.001). 43% of COPD and 23% of noCOPD had low-BL count (p < 0.001). BL decline over time was higher in COPD than noCOPD (p = 0.040). 22.5% of the whole cohort developed cancer which incidence was higher in low-BL subjects and in BL decliners than high-BL (31 vs. 18%; p = 0.001) and no decliners (32 vs. 19%; p = 0.002). 26% in the cohort died during follow-up. Furthermore, low-BL count, BL decline, and age were independent risk factors for mortality by Cox regression analysis. Conclusion: BL count and BL decline are related to worse outcomes in smokers with and without COPD, which suggests that BL count and decline might play a mechanistic role in outcomes deterioration. Insights into mechanisms inducing the fall in BL count could improve the understanding of COPD pathogenesis and point toward new therapeutic measures.

Idioma: Inglés

DOI: 10.1159/000515180

Año: 2021

Publicado en: RESPIRATION 100, 7 (2021), 618-630
ISSN: 0025-7931

Factor impacto JCR: 3.966 (2021)

Categ. JCR: RESPIRATORY SYSTEM rank: 31 / 66 = 0.47 (2021) - Q2 - T2

Factor impacto CITESCORE: 6.4 - Medicine (Q1)

Factor impacto SCIMAGO: 1.084 - Pulmonary and Respiratory Medicine (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)