Anemia Severely Reduces Health-Related Quality of Life in COPD Patients Receiving Long-Term Home Non-Invasive Ventilation

Maximilian Wollsching-Strobel, Sarah Bettina Schwarz, Tim Mathes, Daniel Sebastian Majorski, Pouya Heidari, Doreen Kroppen, Friederike Sophie Magnet, Wolfram Windisch Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne and Witten, North Rhine-Westphalia, GermanyCorrespondence: Wolfram WindischCologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Ostmerheimer Str. 200, Cologne and Witten, North Rhine-Westphalia, D-51109, GermanyTel +49 221 8907 18929Fax +49 221 8907 8305Email windischw@kliniken-koeln.dePurpose: To assess the influence of anemia on health-related quality of life (HRQL) in COPD patients receiving long-term non-invasive ventilation (NIV).Patients and Methods: In this prospective single-center cohort study, COPD patients on long-term NIV were analyzed between June 2015 and May 2020. Linear multiple regression analyses were performed using the results of the Severe Respiratory Insufficiency Questionnaire (SRI) along with the following variables: sex, age, body mass index, duration of NIV, exacerbation history (≤ 1 versus > 1 in the previous year), the updated Charlson comorbidity index, hemoglobin levels and anemia (WHO criteria).Results: Anemia was identified in 32.8% (N=128). Anemia (mean difference − 8.4, 95% CI − 2.0/-14.9 SRI points, P=0.011) and exacerbations (mean difference − 9.9, 95% CI − 4.3/-15.5 SRI points, P=0.001) each had a negative impact on SRI summary scores. Exacerbations were negatively associated with six out of seven SRI subscale scores, while anemia was negatively associated with four out of seven. SRI summary scores dropped by 1.5 points for every g/dl of hemoglobin (P=0.08). No other variables had an influence on the SRI scores.Conclusion: The present study has shown that within a cohort of COPD patients undergoing long-term NIV, one-third were identified as anemic. Furthermore, anemia, like exacerbation history, was found to have a considerable negative impact on HRQL that is specific to patients with chronic respiratory failure.Clinical Trial Registration: German Clinical Trials Registry (DRKS00008759).Keywords: chronic respiratory failure, exacerbations, hemoglobin, non-invasive ventilation, severe respiratory insufficiency questionnaire