Interleucina 6 de pacientes com DPOC em nove anos
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Data
2020-02-19
Autores
Prudente, Robson Aparecido [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: As manifestações sistêmicas da Doença Pulmonar Obstrutiva Crônica (DPOC) estão relacionadas ao aumento do processo inflamatório sistêmico, entretanto, não está totalmente esclarecido o quanto a inflamação sistêmica, em especial a interleucina-6 (IL-6), está associada com o risco de mortalidade. Dessa forma, o objetivo desse estudo consistiu em avaliar a evolução das concentrações séricas da IL-6 e sua associação com a mortalidade de pacientes com DPOC em nove anos. Pacientes e métodos: 133 pacientes foram avaliados no momento basal entre 2004 e 2006 e reavaliados depois de três e nove anos por meio de avaliação clínica, espirometria, oximetria de pulso e gases arteriais, composição corporal, distância percorrida em seis minutos (DP6), qualidade de vida, intensidade de dispneia, Índice BODE, comorbidades, IL-6 e número de exacerbações nos três primeiros anos de seguimento. Resultados: Durante acompanhamento, 19 pacientes perderam seguimento, quatro não tiveram a causa da morte identificada e 18 estavam com dados incompletos; assim, 92 pacientes foram incluídos na análise de mortalidade tendo a IL-6 como covariável tempo dependente. Na reavaliação dos sobreviventes, 64 pacientes morreram, 23 perderam seguimento, 12 recusaram continuar participando e um não pode ser reavaliado em decorrência de exacerbações frequentes; dessa forma, 33 foram incluídos na reavaliação após nove anos. Sobre o perfil inflamatório, nos pacientes que sobreviveram após nove anos, houve aumento significativo da IL-6 [0,4(0,2-0,8) vs 5,7(3,4-11); p<0,001] e redução da contagem de linfócitos [2,1(1,6-2,4) vs 1,4(1,2-2,1); p<0,01] com aumento da relação neutrófilos/linfócitos. O modelo de mortalidade não demonstrou influência estatisticamente significativa da IL-6 avaliada durante o período de seguimento. Conclusão: A IL-6 aumentou progressivamente nos pacientes com DPOC que sobreviveram após nove anos de seguimento, entretanto, não foi preditora de mortalidade durante esse período.
Introduction: Systemic manifestations of Chronic Obstructive Pulmonary Disease (COPD) are related to increased systemic inflammatory process; however, it is not entirely clear how the systemic inflammation, in particular interleukin-6 (IL-6), is associated with mortality risk. Therefore, this study aimed to evaluate the evolution of serum IL-6 concentrations and its association with mortality of COPD patients over nine years. Patients and methods: 133 COPD patients were assessed at baseline between 2004 and 2006 and reassessed after three and nine years through clinical evaluation, spirometry, pulse oximetry and arterial gases, body composition, 6-minute walk distance (6MWD), quality of life, dyspnea intensity, BODE Index, comorbidities, IL-6 and number of exacerbations in the first three years of follow-up. Results: After nine years, 19 patients lost the follow-up, was not possible to identify the date of death of 4 patients and 18 had incomplete data; thus, 92 patients were included in the Cox mortality analysis with IL-6 as a time dependent covariate. In the reassessment of survivors, 64 patients died, 23 lost the follow-up, 12 refused to participate and 1 could not be involved due to recurrent exacerbations; therefore, 33 patients were included in the reassessment after nine years of followup. Regarding the inflammatory profile, in patients who survived after nine years, there was a significant increase in IL-6 [0.4(0.2-0.8) vs 5.7(3.4-11)pg/mL; p<0.001] and reduction in lymphocyte count [2.1(1.6-2.4) vs 1.4(1.2-2.1)10^9/L; p<0.01] with an increase in the neutrophil/ lymphocyte ratio. The Cox mortality model did not show a statistical significance influence of IL6 assessed during the follow-up. Conclusion: There was a progressive increase in IL-6 during the follow-up, however, without influence on mortality.
Introduction: Systemic manifestations of Chronic Obstructive Pulmonary Disease (COPD) are related to increased systemic inflammatory process; however, it is not entirely clear how the systemic inflammation, in particular interleukin-6 (IL-6), is associated with mortality risk. Therefore, this study aimed to evaluate the evolution of serum IL-6 concentrations and its association with mortality of COPD patients over nine years. Patients and methods: 133 COPD patients were assessed at baseline between 2004 and 2006 and reassessed after three and nine years through clinical evaluation, spirometry, pulse oximetry and arterial gases, body composition, 6-minute walk distance (6MWD), quality of life, dyspnea intensity, BODE Index, comorbidities, IL-6 and number of exacerbations in the first three years of follow-up. Results: After nine years, 19 patients lost the follow-up, was not possible to identify the date of death of 4 patients and 18 had incomplete data; thus, 92 patients were included in the Cox mortality analysis with IL-6 as a time dependent covariate. In the reassessment of survivors, 64 patients died, 23 lost the follow-up, 12 refused to participate and 1 could not be involved due to recurrent exacerbations; therefore, 33 patients were included in the reassessment after nine years of followup. Regarding the inflammatory profile, in patients who survived after nine years, there was a significant increase in IL-6 [0.4(0.2-0.8) vs 5.7(3.4-11)pg/mL; p<0.001] and reduction in lymphocyte count [2.1(1.6-2.4) vs 1.4(1.2-2.1)10^9/L; p<0.01] with an increase in the neutrophil/ lymphocyte ratio. The Cox mortality model did not show a statistical significance influence of IL6 assessed during the follow-up. Conclusion: There was a progressive increase in IL-6 during the follow-up, however, without influence on mortality.
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Palavras-chave
Doença Pulmonar Obstrutiva Crônica, Inflamação, Interleucina-6, Índice de Gravidade de Doença, Mortalidade, Chronic obstructive pulmonary disease, Inflammation, Interleukin-6, Severity of Illness Index, Mortality