Kunitomo Yukiko, Putcha Nirupama, Fawzy Ashraf, Raju Sarath, McCormack Meredith C, Wise Robert A, Hansel Nadia N, Balasubramanian Aparna
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Chronic Obstr Pulm Dis. 2025 Jan 29;12(1):72-81. doi: 10.15326/jcopdf.2024.0550.
The impact of iron deficiency on COPD morbidity independent of anemia status is unknown. Understanding the association between iron deficiency, anemia status, and risk of hospitalization in COPD may inform an approach to these comorbidities.
Adults ≥40 years from the Johns Hopkins COPD Precision Medicine Center of Excellence data repository with an outpatient iron profile and 1 year of subsequent follow-up time were included in the study. Baseline characteristics were compared across iron status, defined by transferrin saturation (TSAT), using -tests and Chi-squared tests. The association between continuous TSAT and all-cause hospitalization over the 1-year follow-up period was assessed by logistic regression. Models were adjusted by covariates with an interaction term for anemia and stratified by sex.
There were 6532 individuals included with an average age of 65±12 years, 59% were female, and 56% White. Fifty-two percent of the cohort were iron deficient (TSAT≤20%), among whom 27% were non-anemic. Iron-deficient individuals had lower lung function and a higher prevalence of heart failure and diabetes. Iron deficiency was more prevalent among females (57%) compared to males (44%). In adjusted models, a decrease in TSAT by 10% was associated with 14.3% higher odds of all-cause hospitalization for females (95%CI:1.0-1.3), but not among males (OR:1.08, 95%CI:0.9-1.3). There was effect modification by anemia such that the association between TSAT and all-cause hospitalization was greater in non-anemic women (-value interaction=0.08).
Iron deficiency may be associated with adverse outcomes in the absence of anemia, with non-anemic women being a COPD sub-population particularly sensitive to iron deficiency.
缺铁对慢性阻塞性肺疾病（COPD）发病率的影响（独立于贫血状态）尚不清楚。了解缺铁、贫血状态与COPD住院风险之间的关联可能有助于制定针对这些合并症的治疗方法。
本研究纳入了来自约翰霍普金斯COPD精准医学卓越中心数据存储库的40岁及以上成年人，这些人有门诊铁代谢指标且有1年的后续随访时间。根据转铁蛋白饱和度（TSAT）定义的铁状态，采用t检验和卡方检验比较基线特征。通过逻辑回归评估连续TSAT与1年随访期内全因住院之间的关联。模型通过协变量进行调整，并加入贫血的交互项，按性别分层。
共纳入6532人，平均年龄65±12岁，59%为女性，56%为白人。队列中52%的人缺铁（TSAT≤20%），其中27%无贫血。缺铁个体的肺功能较低，心力衰竭和糖尿病的患病率较高。女性缺铁的患病率（57%）高于男性（44%）。在调整后的模型中，TSAT降低10%与女性全因住院几率增加14.3%相关（95%CI：1.0 - 1.3），但男性无此关联（OR：1.08，95%CI：0.9 - 1.3）。存在贫血的效应修饰，使得TSAT与全因住院之间的关联在非贫血女性中更大（交互P值 = 0.08）。
在无贫血的情况下，缺铁可能与不良结局相关，非贫血女性是对缺铁特别敏感的COPD亚人群。
