Hemoglobin, erythropoietin and systemic inflammation in exacerbations of chronic obstructive pulmonary disease

Eur J Intern Med. 2011 Feb;22(1):103-7. doi: 10.1016/j.ejim.2010.07.010. Epub 2010 Aug 14.


Background: Systemic inflammation may represent a possible cause of anemia. Previous data support that anemic patients with COPD present high erythropoietin (EPO) levels, suggestive of EPO resistance, possibly mediated through inflammatory mechanisms.

Objectives: We aimed to determine whether systemic inflammation, which is usually up-regulated during exacerbations of COPD (ECOPD) is associated with low hemoglobin levels expressing erythropoietin resistance.

Methods: Hemoglobin (Hb), EPO and serum biomarkers of systemic inflammation [CRP, TNF-α, fibrinogen and IL-6] were assessed at three time points (admission, resolution and stable phases) in a selected cohort of 93 COPD patients.

Results: Hemoglobin levels were significantly lower on admission compared to resolution and stable phases (median 12.1 g/dl [interquartile ranges 11.2-12.7], vs 13.5 [12.4-14.3] vs 13.4 [12.7-14.08], respectively p=0.002), whereas EPO was significantly higher on admission compared to resolution and stable phases. A negative association between Hb and IL-6 and a positive association between EPO and IL-6 were observed only during the acute phase of exacerbation. EPO and Hb were negatively associated during the acute phase, whereas they were positively associated during discharge and stable phase.

Conclusions: In this observational study we have shown that during admission for ECOPD Hb levels are decreased and EPO levels are increased. We have also identified a negative association between Hb and EPO. The above association is mainly related to increased IL-6 levels, indicating a possible EPO resistance through the mechanism of increased systemic inflammatory process.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cohort Studies
  • Erythropoietin / blood*
  • Female
  • Hemoglobins / metabolism*
  • Humans
  • Inflammation / blood*
  • Inflammation / complications
  • Interleukin-6 / blood
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / blood*
  • Pulmonary Disease, Chronic Obstructive / complications
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Tumor Necrosis Factor-alpha / blood*


  • Biomarkers
  • Hemoglobins
  • Interleukin-6
  • Tumor Necrosis Factor-alpha
  • Erythropoietin