The impact of COPD on polyneuropathy: results from the German COPD cohort COSYCONET

K Kahnert, M Föhrenbach, T Lucke, P Alter, F T Trudzinski, R Bals, J I Lutter, H Timmermann, S Söhler, S Förderreuther, D Nowak, H Watz, B Waschki, J Behr, T Welte, C F Vogelmeier, R A Jörres, K Kahnert, M Föhrenbach, T Lucke, P Alter, F T Trudzinski, R Bals, J I Lutter, H Timmermann, S Söhler, S Förderreuther, D Nowak, H Watz, B Waschki, J Behr, T Welte, C F Vogelmeier, R A Jörres

Abstract

Background: Peripheral neuropathy is a common comorbidity in COPD. We aimed to investigate associations between alterations commonly found in COPD and peripheral neuropathy, with particular emphasize on the distinction between direct and indirect effects.

Methods: We used visit 4 data of the COPD cohort COSYCONET, which included indicators of polyneuropathy (repeated tuning fork and monofilament testing), excluding patients with diabetes a/o increased HbA1c. These indicators were analysed for the association with COPD characteristics, including lung function, blood gases, 6-min walk distance (6-MWD), timed-up-and-go-test (TUG), exacerbation risk according to GOLD, C-reactive protein (CRP), and ankle-brachial index (ABI). Based on the results of conventional regression analyses adjusted for age, BMI, packyears and gender, we utilized structural equation modelling (SEM) to quantify the network of direct and indirect relationships between parameters.

Results: 606 patients were eligible for analysis. The indices of polyneuropathy were highly correlated with each other and related to base excess (BE), ABI and TUG. ABI was linked to neuropathy and 6-MWD, exacerbations depended on FEV1, 6-MWD and CRP. The associations could be summarized into a SEM comprising polyneuropathy as a latent variable (PNP) with three measured indicator variables. Importantly, PNP was directly dependent on ABI and particularly on BE. When also including patients with diabetes and/or elevated values of HbA1c (n = 742) the SEM remained virtually the same.

Conclusion: We identified BE and ABI as major determinants of peripheral neuropathy in patients with COPD. All other associations, particularly those with lung function and physical capacity, were indirect. These findings underline the importance of alterations of the micromilieu in COPD, in particular the degree of metabolic compensation and vascular status.

Keywords: Ankle-brachial-index; Base excess; COPD; Peripheral neuropathy.

Conflict of interest statement

The authors declare that they have no competing interests. Financial support provided to individuals is disclosed on the conflict of interest declaration provided from each single author.

Figures

Fig. 1
Fig. 1
Structural equation model (SEM). For regression and correlation coefficients see Table 2. Unidirectional arrows indicate a relationship in terms of a linear regression, and double-headed arrows a correlation between variables. All rectangles represent observed variables, whereby the error terms for dependent variables (those, to which at least one arrow points) have been omitted for the sake of clarity. The oval represents a latent variable (construct PNP) comprising the three peripheral neuropathy measures as indicator variables. The structure of relationships illustrates that BE and ABI had effects on the total construct PNP, whereas the lung function parameters showed different relationships to other variables and therefore could not be summarized into a construct

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