Circulating testosterone levels and health outcomes in chronic obstructive pulmonary disease: results from ECLIPSE and ERICA

Holly Pavey; Michael I Polkey; Charlotte E Bolton; Joseph Cheriyan; Carmel M McEniery; Ian Wilkinson; Divya Mohan; Richard Casaburi; Bruce E Miller; Ruth Tal-Singer; Marie Fisk

doi:10.1136/bmjresp-2022-001601

Circulating testosterone levels and health outcomes in chronic obstructive pulmonary disease: results from ECLIPSE and ERICA

BMJ Open Respir Res. 2023 Jun;10(1):e001601. doi: 10.1136/bmjresp-2022-001601.

Authors

Holly Pavey¹, Michael I Polkey², Charlotte E Bolton^{3

4}, Joseph Cheriyan^{5

6}, Carmel M McEniery⁵, Ian Wilkinson⁵, Divya Mohan⁷, Richard Casaburi⁸, Bruce E Miller⁷, Ruth Tal-Singer⁷, Marie Fisk⁵

Affiliations

¹ Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK hp409@medschl.cam.ac.uk.
² Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.
³ Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
⁴ NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
⁵ Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK.
⁶ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁷ Former employee of GSK, Collegeville, Pennsylvania, USA.
⁸ Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.

Abstract

The relationship of circulating testosterone levels with health outcomes in people with chronic obstructive pulmonary disease (COPD) is unknown.

Aim: To determine whether serum testosterone levels predict hospitalised acute exacerbations of COPD (H-AECOPD), cardiovascular disease outcome, and mortality in people with COPD.

Methods: Separate analyses were carried out on two observational, multicentre COPD cohorts, Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) and Evaluation of the Role of Inflammation in Chronic Airways Disease (ERICA), both of which had serum testosterone measured using a validated liquid chromatography assay at the same laboratory. Data from 1296 male participants in ECLIPSE and 386 male, 239 female participants in ERICA were analysed. All analyses were sex-specific. Multivariate logistic regression was used to determine associations with H-AECOPD during follow-up (3 years ECLIPSE, 4.5 years ERICA), a composite endpoint of cardiovascular hospitalisation and cardiovascular death, and all-cause mortality.

Results: Mean (SD) testosterone levels were consistent across cohorts; 459 (197) and 455 (200) ng/dL for males in ECLIPSE and ERICA, respectively, and in ERICA females: 28 (56) ng/dL. Testosterone was not associated with H-AECOPD (ECLIPSE: OR: 0.76, p=0.329, ERICA males: OR (95% CI): 1.06 (0.73 to 1.56), p=0.779, ERICA females: OR: 0.77 (0.52 to 1.12), p=0.178) or cardiovascular hospitalisation and death. Testosterone was associated with all-cause mortality in Global Initiative for Obstructive Lung Disease (GOLD) stage 2 male patients only, in ECLIPSE (OR: 0.25, p=0.007) and ERICA (OR: (95% CI): 0.56 (0.32 to 0.95), p=0.030).

Conclusions: Testosterone levels do not relate to H-AECOPD or cardiovascular outcome in COPD, but are associated with all-cause mortality in GOLD stage 2 COPD male patients, although the clinical significance of this finding is uncertain.

Keywords: COPD Exacerbations; COPD epidemiology; Clinical Epidemiology.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases*
Clinical Relevance
Female
Hospitalization
Humans
Inflammation
Male
Pulmonary Disease, Chronic Obstructive*

Abstract

Publication types

MeSH terms

Grants and funding