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ECLIPSE: Men with COPD, hypogonadism at greater risk for mortality
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HOUSTON — Low testosterone levels predicted an increased risk for mortality, particularly in patients with chronic obstructive pulmonary disease, based on evidence from the observational ECLIPSE study.
Richard V. Clark, PhD, MD, director of Discovery Medicine in the Metabolic Therapeutic area of GlaxoSmithKline Research and Development in Durham, N.C., said previous studies have shown that hypogonadism is associated with an increased risk for mortality during a presentation at the Endocrine Society’s 94th Annual Meeting & Expo.
“This survey of looking at a large, well-characterized population of men with a chronic illness — in this case [chronic obstructive pulmonary disease] — was able to show a few correlations with testosterone, but nothing extensive,” Clark said.
Researchers examined the link between total testosterone levels in 1,296 men with chronic obstructive pulmonary disease (COPD) to outcomes and phenotypes from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Patients were studied in 46 centers within 12 countries and categorized in stages II through IV of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. They were followed for 3 years.
Testosterone was measured by turbulent flow liquid chromatography–tandem mass spectrometry (LC/MS/MS) and free testosterone was measured by equilibrium dialysis from samples taken at month 6.
“Testosterone was an independent predictor of mortality,” Clark said.
The median testosterone level was 439 ng/dL, and low testosterone was not found to be correlated with the percentage of predicted forced expiratory volume in one second (FEV1); however, it was strongly correlated with higher BMI (Spearman’s rank correlation coefficient=–0.47) and lower percentage of predicted total lung capacity (Spearman’s rank correlation coefficient=0.21; each P<.001).
According to data, low testosterone was also found to be statistically significant as it related to higher age, shorter 6-minute walk distance and lower emphysema score on a CT scan (P<.05).
When Clark and colleagues performed a univariate analysis, they found that death was more likely to occur in patients with low testosterone levels (OR=0.51; P<.054). Similarly, lower testosterone levels significantly predicted death in patients with stage II COPD (OR=0.24; P<.003).
Multivariate linear regression analysis took into account: age, percentage of predicted FEV1, BMI, smoking status and testosterone level. COPD hospitalization and patient death were predicted by age and percentage FEV1. Yet, testosterone levels were not predictive of COPD hospitalization. Rather, it was only predictive of higher patient death in those with GOLD stage II COPD (OR=0.25; P<.007).
Data showed that median free testosterone levels of 206 pmol/L confirmed the total testosterone findings and did not contribute to the analyses. – by Samantha Costa
For more information:
Wang C. Abstract #OR28-5. Presented at: the Endocrine Society’s 94th Annual Meeting & Expo; June 23-26, 2012; Houston.
Disclosure: Several of the researchers are employees for GlaxoSmithKline.