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and who had not presented acute exacerbations in the previous 2 months were enrolled&#46; The study took place between July 2008 and June 2010&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In order to avoid possible selection bias&#44; all patients diagnosed with bronchial asthma and those who had any disease or comorbidity that could affect haemoglobin levels and&#47;or inflammatory markers were excluded &#40;patients with thyroid disease&#44; history of cancer in the last 5 years&#44; liver disease&#44; chronic heart failure&#44; chronic renal failure&#44; chronic inflammatory rheumatic disease&#44; previous history of gastrointestinal bleeding or blood loss&#44; vitamin B<span class="elsevierStyleInf">12</span> and folic acid deficiency&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study was approved by the hospital Ethics Committee&#46; All patients signed an informed consent before undergoing any study procedure&#46; The patient&#39;s medical record was reviewed and they had a personal interview to confirm the absence of exclusion criteria&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The following epidemiological data were recorded&#58; weight&#44; height&#44; body mass index &#40;BMI&#41;&#44; grade of dyspnoea according to the modified <span class="elsevierStyleItalic">Medical Research Council</span> &#40;mMRC&#41; scale&#44; quality of life measured using the EQ-5D&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> history of smoking&#44; usual pharmacological treatment&#44; comorbidity measured using the Charlson index and number of moderate and severe exacerbations in the previous 12 months&#46; All patients underwent forced spirometry with a bronchodilator test &#40;Masterlab Screen Body Jaeger&#41;&#44; 6-minute walk test and baseline arterial blood gases&#44; and the BODE index was calculated &#40;body mass index &#91;B&#93;&#44; airflow obstruction measured using the forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; &#91;O&#93;&#44; dyspnoea measured using the mMRC scale &#91;D&#93; and exercise capacity measured using the 6-minute walk test &#91;E&#93;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A peripheral venous blood sample was obtained for analysis of complete blood count&#44; fibrinogen&#44; serum biochemistry and erythropoietin &#40;immunometric assay with chemiluminescent detection&#58; Immulite 2000&#44; Siemens&#41;&#46; One of the peripheral blood samples was centrifuged and aliquoted before freezing at &#8722;70<span class="elsevierStyleHsp" style=""></span>&#176;C for subsequent analysis of inflammatory markers &#40;IL-6&#44; IL-8&#44; TNF-&#945;&#44; high-sensitivity C-reactive protein &#91;CRP&#93;&#41;&#46; Interleukins and TNF-&#945; were analysed using an enzyme immunoassay technique &#40;DRG diagnostic&#44; GmbH&#44; Germany&#41; with detection limits of 2<span class="elsevierStyleHsp" style=""></span>pg&#47;mL for IL-6&#44; 1&#46;1<span class="elsevierStyleHsp" style=""></span>pg&#47;mL for IL-8 and 0&#46;7<span class="elsevierStyleHsp" style=""></span>pg&#47;mL for TNF-&#945;&#46; High-sensitivity CRP was analysed by automated nephelometry &#40;BNprospect&#44; Siemens&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients who were included initially in the study but who subsequently presented abnormal thyroid hormone values &#40;either high or low&#41;&#44; vitamin B<span class="elsevierStyleInf">12</span> and folic acid deficiency&#44; glomerular filtration rate &#40;GFR&#41; below 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and increased liver enzymes twice the upper limit of normal were excluded from the final analysis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Anaemia was defined &#40;according to WHO criteria&#41; as the presence of haemoglobin levels &#60;13<span class="elsevierStyleHsp" style=""></span>g&#47;dL in males and &#60;12<span class="elsevierStyleHsp" style=""></span>g&#47;dL in females&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Sample Size</span><p id="par0055" class="elsevierStylePara elsevierViewall">The following data were taken into account for calculating the sample size&#58; 80&#37; of patients with COPD and anaemia have high inflammatory markers and 20&#37; of patients with COPD without anaemia also have them&#46; Therefore&#44; 17 patients would have to be included in each group for a 95&#37; confidence interval and a statistical power of 90&#37;&#46; Considering recent publications that estimate that the prevalence of anaemia in stable COPD is 13&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> a total of 130 patients would have to be included in the study to reach this number of patients in the COPD and anaemia group&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical Analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Equality of means in the variables between patients with and without anaemia was tested using bootstrap analysis&#44; since the samples from individuals with anaemia have an n of between 6 and 8 individuals and&#44; therefore&#44; it is not correct to compare and&#47;or assume the hypothesis of normality&#46; This method was therefore selected&#44; as it does not require the assumption of certain patterns of behaviour&#46; The maximum number of regenerated non-repeat samples is not arbitrary but depends on the sample size&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> In this study&#44; it varied from 300 to 5000 replicates&#44; depending on the number of patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In order to study the correlation between the variables&#44; we used the Kendall Tau-b and Spearman Rho coefficients&#44; non-parametric measures based on ranges&#44; which allow bivariate relationships to be compared&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> A <span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 was considered significant&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS version 19 and&#44; for the bootstrap&#44; &#64;RISK 4&#46;5&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">One hundred and forty-seven patients diagnosed with COPD and under follow-up in outpatients were initially included&#44; of whom 17 were excluded from the final analysis because they presented some of the previously described exclusion criteria&#46; The most common cause of exclusion was renal failure in 6 cases &#40;35&#37;&#41;&#44; followed by absence of COPD diagnosis &#40;5 cases&#44; 29&#46;4&#37;&#41;&#44; abnormal thyroid profile &#40;2 cases&#41; and abnormal folic acid&#47;vitamin B<span class="elsevierStyleInf">12</span> levels &#40;2 cases&#58; one due to abnormal liver profile and the other due to chronic heart failure&#41;&#46; The prevalence of anaemia in COPD patients who were excluded &#40;12&#41; was 16&#46;6&#37;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 130 patients finally included in the study&#44; 8 had anaemia&#44; which represents a prevalence of 6&#46;2&#37;&#46; In all cases&#44; it was defined as normochromic normocytic anaemia with a high coefficient of variation in the mean cell volume&#44; with low iron and normal transferrin and ferritin levels&#46; These data are consistent with anaemia of chronic disease&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The anaemia was mild in most cases&#44; with a mean haemoglobin value of 11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;95<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#46; The main characteristics of patients in our series and the differences in the epidemiological characteristics and analytical data between the group of cases with and without anaemia are shown in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Patients in the anaemia group had a lower BMI &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#44; higher Charlson index &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;002&#41; and higher erythropoietin levels &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;016&#41;&#46; Patients with anaemia had more severe COPD in terms of the post-bronchodilator FEV<span class="elsevierStyleInf">1</span>&#37;&#44; although this did not reach statistical significance &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;08&#41;&#46; There were no differences in the age&#44; sex&#44; smoking history&#44; dyspnoea&#44; quality of life &#40;measured using the EQ-5D&#41;&#44; arterial PaO<span class="elsevierStyleInf">2</span> or PaCO<span class="elsevierStyleInf">2</span> values&#44; exacerbations in the previous year&#44; score in the BODE index or metres covered in the 6-minute walk test between patients with and without anaemia&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The haemoglobin levels showed an inverse correlation with the Charlson index &#40;Kendall&#39;s Tau-b&#61;0&#46;13&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;046&#44; and Spearman&#39;s Rho&#61;0&#46;17&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;044&#41; and with the erythropoietin levels &#40;Kendall&#39;s Tau-b&#61;&#8722;0&#46;15&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;020&#44; and Spearman&#39;s Rho&#61;&#8722;0&#46;21&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;022&#41;&#46; The correlations with the other parameters analysed&#44; including the PaO<span class="elsevierStyleInf">2</span>&#44; PaCO<span class="elsevierStyleInf">2</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#37;&#44; distance covered in the 6-minute walk test&#44; cumulative smoking &#40;pack-years&#41; or BODE index were not significant&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The usual treatment of patients in each group was recorded&#46; Four patients with anaemia were on treatment with angiotensin II receptor blockers compared to 14 patients in the group without anaemia &#40;50&#37; vs 11&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#44; and one patient with anaemia was on treatment with angiotensin-converting-enzyme inhibitors compared to 21 in the group without anaemia &#40;12&#46;5&#37; vs 17&#46;2&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;61&#41;&#46; The prevalence of anaemia in COPD patients not treated with these drugs was 3&#46;3&#37;&#46; Only 6 of the 130 patients were on theophylline treatment&#44; none of whom had anaemia&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the patient distribution according to the degree of obstruction&#58; 8&#46;8&#37; of patients with very severe COPD had anaemia compared to 0&#37; in patients with mild COPD&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the inflammatory markers analysed&#46; The group of patients with anaemia had significantly lower IL-6 values&#44; but no differences were found in the other parameters&#46; A direct correlation was observed between the haemoglobin levels and serum IL-6 levels &#40;Kendall&#39;s Tau-b&#61;0&#46;16&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;018&#44; and Spearman&#39;s Rho&#61;&#8722;0&#46;20&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;021&#41;&#46; Correlations with the other inflammatory parameters analysed were not significant&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our study&#44; the prevalence of anaemia was 6&#46;2&#37;&#44; which is lower than most figures published to date&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;11</span></a> All show a prevalence above 10&#37;&#44; except for those by Watz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and Nowinski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> These differences in prevalence are most likely due to methodological differences between studies&#58; most are retrospective studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> analysis of different populations&#58; stable or exacerbated&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a> outpatients<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;9</span></a> or inpatients<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a>&#59; different definitions of anaemia<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a>&#59; different grades of obstruction with FEV<span class="elsevierStyleInf">1</span> between 37&#37;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and 56&#37;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#59; and confounding factors included in the analysis&#44; such as heart failure&#44; renal failure or associated neoplasms&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">There are reports that show that the prevalence and severity of anaemia in the general population increase with age and are related with the patient&#39;s underlying condition&#46; Thus&#44; in the study by Guralnik et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> the prevalence of anaemia of unknown cause in the group aged between 50 and 64 years was 4&#46;4&#37; in men and 6&#46;8&#37; in women&#44; while in the group aged between 64 and 74 years it was 7&#46;8&#37; in men and 8&#46;5&#37; in women&#46; These values are similar to those found in our study&#44; where the mean age was 64&#46;2 years &#40;SD&#61;8&#46;4&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The main aim of our study was to determine the prevalence of anaemia not attributable to other causes in COPD patients&#44; and for this reason&#44; cases with other known causes of anaemia&#44; as described in the study methods&#44; were excluded&#46; The Charlson index for the population included in our study is around 2&#46; Of these&#44; 43&#37; of patients had hypertension&#44; 33&#37; hypercholesterolaemia and 16&#37; diabetes mellitus&#46; These data are very similar to those of other studies evaluating the presence of comorbidities in COPD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> This confirms that our sample is a representative population of patients with COPD and their spectrum of the most common comorbidities&#44; since only those that could cause anaemia were excluded&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The anaemia was generally mild &#40;mean haemoglobin values of 11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;95<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; and its characteristics were consistent with anaemia of chronic disease&#44; similar to other previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;9</span></a> Having applied very strict exclusion criteria&#44; our study suggests that the prevalence of anaemia not attributable to other causes in stable COPD patients is lower than found up to now in the literature&#44; and may be close to the prevalence of anaemia in the general population in the same age range&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Although it did not reach statistical significance&#44; patients with anaemia had a tendency to have more severe COPD in terms of FEV<span class="elsevierStyleInf">1</span>&#44; with a prevalence of anaemia in patients with very severe COPD close to 9&#37;&#46; Most previous studies do not describe a relationship between the prevalence of anaemia and the severity of the COPD&#44; except for the one by Watz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in which the prevalence of anaemia was higher in patients with very severe COPD &#40;14&#37;&#41;&#44; and that of Boutou et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in which the group with anaemia had a lower FEV<span class="elsevierStyleInf">1</span> than the group without anaemia&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Few studies have analysed the impact of anaemia on patients with COPD&#46; The efficiency of gas exchange depends on haemoglobin levels&#59; if these fall&#44; that exchange and&#44; therefore&#44; the exercise capacity could worsen&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In our study&#44; no differences were observed with respect to the dyspnoea scale&#44; or in metres covered in the 6-minute walk test&#44; unlike two previous studies that analysed these parameters&#44; in which patients with anaemia had a higher grade of dyspnoea and covered less distance in the 6-minute walk test&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Although there is increasing data in relation to the role of systemic inflammation in COPD&#44; few studies mention the physiopathology of COPD-associated anaemia&#46; In theory&#44; this could be similar to other chronic inflammatory diseases&#44; where it has been postulated that its origin could be in an immunological and inflammatory response&#44; mediated by TNF-&#945;&#44; IL-1&#44; IL-6 and interferon gamma&#44; which would generate changes in iron metabolism&#44; reducing its intestinal absorption and altering haematopoiesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;24</span></a> In patients with COPD&#44; there is an increase in these mediators&#44; which could be considered as factors related with the onset of anaemia associated with this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> In our study&#44; the anaemia presented findings consistent with anaemia of chronic disease&#44; and as in two other previous studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;25</span></a> it presented with low iron and significantly higher erythropoietin levels&#44; which support the theory of peripheral resistance to the action of erythropoietin mediated by an inflammatory component&#46; These findings&#44; which are common to other chronic diseases that present with anaemia&#44; are important&#44; as studies have recently been carried out suggesting that the correction of iron deficiency in patients with heart failure could improve their prognosis&#44; thereby opening new therapeutic targets to be studied in the future&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Only one previous paper<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> compared interleukin and CRP values in COPD patients with and without anaemia in relation to healthy controls&#46; In this study&#44; IL-6 and CRP were significantly higher in COPD patients than in controls&#44; with no differences found in the other interleukins &#40;IL-8 and IL-10&#41;&#46; In the COPD group&#44; patients with anaemia had significantly higher CRP values than non-anaemic patients&#44; but no differences were found in the IL-6&#44; IL-8 and IL-10 values&#46; In our study&#44; we found a non-significant increase in CRP levels&#44; and patients with anaemia had significantly lower IL-6 values and a direct correlation between the haemoglobin and IL-6 levels&#46; We did not find a physiopathological explanation for these findings&#44; which should be confirmed in future studies&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Moreover&#44; there are other added factors that influence the erythropoietic response and which also may be present in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Thus&#44; it is known that certain drugs may influence haemoglobin levels&#44; such as angiotensin-converting-enzyme inhibitors and angiotensin II receptor inhibitors&#44; which cause a decrease in haemoglobin and erythropoietin levels&#46; These drugs are often used for the treatment of hypertension and&#44; according to some studies&#44; the prevalence of this condition in COPD patients could be around 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Other treatments&#44; such as theophylline&#44; may also influence erythropoiesis&#44; by a complex mechanism of apoptosis induced by the drug itself&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> In our study&#44; 50&#37; of patients with anaemia were on treatment with angiotensin II receptor blockers compared to 11&#46;5&#37; of the group without anaemia &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#44; although no differences were found in relation to the use of other drugs such as angiotensin-converting-enzyme inhibitors and theophyllines&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Our study is not free of limitations&#44; especially those that could be derived from the sample size or the use of some exclusion criteria not included in previous studies&#44; which could limit the comparison of our data with previously published results&#46; Despite this&#44; our data are interesting&#44; as they show a lower prevalence of COPD-associated anaemia than previously described and open the door to physiopathological theories that could explain the onset of anaemia in these patients&#46; Further studies with larger COPD populations and stricter inclusion criteria are required in order to eliminate confounding factors&#44; and which allow a better understanding of the onset of anaemia in these patients from a physiopathological point of view and of the clinical and prognostic implications&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This study was partially funded by <span class="elsevierStyleGrantSponsor" id="gs0005">GlaxoSmithKline S&#46;A&#46;</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs0005">CRT114268</span>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of Interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anaemia is one of the extrapulmonary manifestations of chronic obstructive pulmonary disease &#40;COPD&#41;&#46; Its real prevalence&#44; physiopathology and clinical repercussion are unknown&#46; The objectives of our study were&#58; to determine the prevalence of anaemia in patients with stable COPD not attributable to other causes and to establish the relationship of anaemia with clinical&#44; prognostic and inflammatory markers with an important role in COPD&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study included stable COPD patients with no other known causes of anaemia&#46; The following tests were carried out&#58; respiratory function tests&#59; serum determination of erythropoietin and inflammatory markers&#58; high sensitivity <span class="elsevierStyleSmallCaps">C</span>-reactive protein &#40;hs-CRP&#41;&#44; fibrinogen&#44; interleukin 6 &#40;IL-6&#41;&#44; interleukin 8 &#40;IL-8&#41; and tumour necrosis factor &#945; &#40;TNF-&#945;&#41;&#46; Body mass index &#40;BMI&#41;&#44; Charlson and BODE indices&#44; the number of exacerbations in the previous year&#44; dyspnoea and quality of life were also calculated&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">One hundred and thirty patients were included&#46; Anaemia prevalence was 6&#46;2&#37;&#46; Mean haemoglobin value in anaemic patients was 11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;95<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#46; Patients with anaemia had a lower BMI &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#44; higher Charlson index &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;002&#41;&#44; more elevated erythropoietin levels &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;016&#41;&#44; a tendency to present a lower FEV<span class="elsevierStyleInf">1</span>&#37; value &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;08&#41; and significantly lower IL-6 values when compared to non-anaemic patients &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our series&#44; the anaemia associated with COPD was less prevalent than that published in the literature to date&#44; and was related to certain clinical and inflammatory markers&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La anaemia es una de las manifestaciones extrapulmonares de la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41;&#46; Su prevalencia&#44; su fisiopatolog&#237;a y su repercusi&#243;n cl&#237;nica son desconocidas&#46; Los objetivos de nuestro estudio son determinar la prevalencia de la anaemia en pacientes con EPOC en fase estable no atribuible a otras causas y establecer la relaci&#243;n de la anaemia con variables cl&#237;nicas&#44; pron&#243;sticas y marcadores inflamatorios con un papel relevante en la EPOC&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron pacientes con EPOC en fase estable sin otras causas conocidas de anaemia&#46; Se realizaron pruebas de funci&#243;n respiratoria&#44; determinaci&#243;n de eritropoyetina y marcadores inflamatorios s&#233;ricos&#58; PCR ultrasensible &#40;PCR&#41;&#44; fibrin&#243;geno&#44; interleucina 6 &#40;IL-6&#41;&#44; interleucina 8 &#40;IL-8&#41; y factor de necrosis tumoral alfa &#40;TNF-&#945;&#41;&#46; Se registr&#243; el &#237;ndice de masa corporal &#40;IMC&#41;&#44; el &#237;ndice de Charlson y el BODE&#44; el n&#250;mero de exacerbaciones en el a&#241;o previo&#44; la escala de disnea y la calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 130<span class="elsevierStyleHsp" style=""></span>pacientes&#46; La prevalencia de anaemia fue del 6&#44;2&#37;&#46; El valour de hemoglobina en los pacientes con anaemia fue de 11&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;95<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#46; Los pacientes con anaemia ten&#237;an un IMC m&#225;s bajo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; un &#237;ndice de Charlson mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; niveles de eritropoyetina m&#225;s elevados &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; una tendencia a presentar niveles m&#225;s bajos de FEV<span class="elsevierStyleInf">1</span>&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;08&#41; y valores significativamente m&#225;s bajos de IL-6 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; cuando se comparan con los pacientes no an&#233;micos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En nuestra serie&#44; la anaemia asociada a la EPOC es menos prevalente de lo publicado hasta la actualidad y guarda relaci&#243;n con determinados factores cl&#237;nicos y marcadores inflamatorios&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Comeche Casanova L&#44; et al&#46; Prevalencia de anemia asociada a la enfermedad pulmonar obstructiva cr&#243;nica&#46; Estudio de las variables asociadas&#46; Arch Bronconeumol&#46; 2013&#59;49&#58;383-387&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The values are shown in mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#44; except for gender and treatment with angiotensin II receptor blockers&#44; which are expressed as number of patients and percentage&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Patients without anaemia &#40;n&#61;122&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with anaemia &#40;n&#61;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Sex&#44; males&#59; n and &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">110 &#40;90&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Smoking&#44; packs-year&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">57&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">63&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>39&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">FEV<span class="elsevierStyleInf">1</span> post BD&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">41&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">FEV<span class="elsevierStyleInf">1</span>&#47;FVC post BD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PaO<span class="elsevierStyleInf">2</span>&#44; mmHg&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">65&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PaCO<span class="elsevierStyleInf">2</span>&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyspnoea&#44; mMRC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EQ-5D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EQ5VAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Charlson Index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BODE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distance covered in the walk test&#44; m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">418&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">375&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>112&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exacerbations in the previous year&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment with angiotensin II receptor blockers&#44; number of patients and &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab392504.png"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">General Characteristics of Patients Included in the Study&#46; Differences Between Groups&#46;</p>"
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      ]
      1 => array:7 [
        "identificador" => "tbl0010"
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">MCHC&#44; mean cell haemoglobin concentration&#59; MCV&#44; mean cell volume&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Values are shown as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients without anaemia &#40;n&#61;122&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with anaemia &#40;n&#61;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haemoglobin&#44; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&#177;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9&#177;0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haematocrit&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;6&#177;3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;8&#177;2&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MCV&#44; fl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;76&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;9&#177;8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MCHC&#44; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;9&#177;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;2&#177;1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Iron&#44; &#956;g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;4&#177;29&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;6&#177;42&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ferritin&#44; ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&#46;6&#177;123&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115&#46;3&#177;148&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transferrin&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256&#46;4&#177;35&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">273&#46;1&#177;62&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythropoietin&#44; mU&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&#177;13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;1&#177;17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;0016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab392501.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Characteristics of Analytical Parameters&#46; Differences Between Groups&#46;</p>"
        ]
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      2 => array:7 [
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        "etiqueta" => "Table 3"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The percentages in each cell correspond to the percentage of patients for each obstruction grade&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grade of obstruction</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mild &#40;n&#61;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Moderate &#40;n&#61;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Severe &#40;n&#61;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Very severe &#40;n&#61;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients without anaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;94&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;94&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">31 &#40;91&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with anaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;8&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patient Distribution According to Grade of Obstruction&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Patients without anaemia &#40;n&#61;122&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with anaemia &#40;n&#61;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">High-sensitivity CRP&#44; mg&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7&#46;1&#177;17&#46;1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#46;8&#177;26&#46;9 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">IL-6&#44; pg&#47;mL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23&#46;7&#177;91&#46;4 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;3&#177;5 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL-8&#44; pg&#47;mL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;8&#177;72&#46;8 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>120&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;8&#177;21&#46;7 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">TNF-&#945;&#44; pg&#47;mL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;5&#177;2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>121&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;1&#177;2&#46;1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">371&#46;4&#177;97&#46;9 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">424&#46;5&#177;132&#46;5 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;18&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Blood High-Sensitivity CRP&#44; IL-6&#44; IL-8&#44; TNF-&#945; and Fibrinogen Values&#46; Differences Between Groups&#46;</p>"
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                  "referenciaCompleta" => "From the Global Strategy for the Diagnosis&#44; Management and Prevention of COPD&#44; Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41; Update 2013&#46; Available from&#58; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.goldcopd.org/">http&#58;&#47;&#47;www&#46;goldcopd&#46;org</a>&#46;"
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                          "autores" => array:2 [
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                      "doi" => "10.1183/09031936.00128008"
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Original Article
Prevalence of Anaemia Associated With Chronic Obstructive Pulmonary Disease. Study of Associated Variables
Prevalencia de anemia asociada a la enfermedad pulmonar obstructiva crónica. Estudio de las variables asociadas
Lorena Comeche Casanovaa,
Corresponding author
lacomeche.mad@quiron.es

Corresponding author.
, Jose María Echave-Sustaetaa, Ricardo García Lujána, Irene Albarrán Lozanob, Pablo Alonso Gonzálezc, María Jesús Llorente Alonsod
a Servicio de Neumología, Hospital Universitario Quirón Madrid, Universidad Europea de Madrid, Madrid, Spain
b Departamento de Estadística, Universidad Carlos III, Madrid, Spain
c Departamento de Estadística, Estructura Económica y Organización Económica Internacional, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
d Servicio de Bioquímica, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
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    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Prevalencia de anemia asociada a la enfermedad pulmonar obstructiva cr&#243;nica&#46; Estudio de las variables asociadas"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is fundamentally characterised by the presence of airflow limitation that is not fully reversible&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Great importance has recently been given to the role of inflammation in this disease&#44; and may explain some of the extrapulmonary manifestations of COPD described in recent years&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> such as weight loss&#44; muscle atrophy&#44; increase in cardiovascular morbidity and mortality&#44; altered bone metabolism&#44; anaemia and depression&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of anaemia in COPD varies widely according the study&#44; and ranges between 4&#46;9&#37; and 33&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;12</span></a> This disparity in the data could be due to various factors&#44; such as the retrospective nature of some studies&#44; use of heterogeneous populations &#40;COPD in a stable or exacerbated phase&#59; outpatients or inpatients&#41;&#44; the use of different cut-off points to define anaemia and the existence of confounding factors such as the presence of other known causes of anaemia&#44; like heart failure&#44; renal failure&#44; neoplasms&#44; etc&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore&#44; we designed an epidemiological&#44; observational&#44; prospective study that would allow us&#44; on one side&#44; to determine the prevalence of anaemia not attributable to other causes in a sample of our patients with stable COPD&#44; and on the other&#44; to analyse the relationship of the anaemia with clinical and prognostic variables and inflammatory markers with a relevant role in COPD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Patients diagnosed with COPD according to GOLD criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> followed-up in Respiratory Medicine outpatients&#44; and who had not presented acute exacerbations in the previous 2 months were enrolled&#46; The study took place between July 2008 and June 2010&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In order to avoid possible selection bias&#44; all patients diagnosed with bronchial asthma and those who had any disease or comorbidity that could affect haemoglobin levels and&#47;or inflammatory markers were excluded &#40;patients with thyroid disease&#44; history of cancer in the last 5 years&#44; liver disease&#44; chronic heart failure&#44; chronic renal failure&#44; chronic inflammatory rheumatic disease&#44; previous history of gastrointestinal bleeding or blood loss&#44; vitamin B<span class="elsevierStyleInf">12</span> and folic acid deficiency&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The study was approved by the hospital Ethics Committee&#46; All patients signed an informed consent before undergoing any study procedure&#46; The patient&#39;s medical record was reviewed and they had a personal interview to confirm the absence of exclusion criteria&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The following epidemiological data were recorded&#58; weight&#44; height&#44; body mass index &#40;BMI&#41;&#44; grade of dyspnoea according to the modified <span class="elsevierStyleItalic">Medical Research Council</span> &#40;mMRC&#41; scale&#44; quality of life measured using the EQ-5D&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> history of smoking&#44; usual pharmacological treatment&#44; comorbidity measured using the Charlson index and number of moderate and severe exacerbations in the previous 12 months&#46; All patients underwent forced spirometry with a bronchodilator test &#40;Masterlab Screen Body Jaeger&#41;&#44; 6-minute walk test and baseline arterial blood gases&#44; and the BODE index was calculated &#40;body mass index &#91;B&#93;&#44; airflow obstruction measured using the forced expiratory volume in one second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; &#91;O&#93;&#44; dyspnoea measured using the mMRC scale &#91;D&#93; and exercise capacity measured using the 6-minute walk test &#91;E&#93;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A peripheral venous blood sample was obtained for analysis of complete blood count&#44; fibrinogen&#44; serum biochemistry and erythropoietin &#40;immunometric assay with chemiluminescent detection&#58; Immulite 2000&#44; Siemens&#41;&#46; One of the peripheral blood samples was centrifuged and aliquoted before freezing at &#8722;70<span class="elsevierStyleHsp" style=""></span>&#176;C for subsequent analysis of inflammatory markers &#40;IL-6&#44; IL-8&#44; TNF-&#945;&#44; high-sensitivity C-reactive protein &#91;CRP&#93;&#41;&#46; Interleukins and TNF-&#945; were analysed using an enzyme immunoassay technique &#40;DRG diagnostic&#44; GmbH&#44; Germany&#41; with detection limits of 2<span class="elsevierStyleHsp" style=""></span>pg&#47;mL for IL-6&#44; 1&#46;1<span class="elsevierStyleHsp" style=""></span>pg&#47;mL for IL-8 and 0&#46;7<span class="elsevierStyleHsp" style=""></span>pg&#47;mL for TNF-&#945;&#46; High-sensitivity CRP was analysed by automated nephelometry &#40;BNprospect&#44; Siemens&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients who were included initially in the study but who subsequently presented abnormal thyroid hormone values &#40;either high or low&#41;&#44; vitamin B<span class="elsevierStyleInf">12</span> and folic acid deficiency&#44; glomerular filtration rate &#40;GFR&#41; below 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and increased liver enzymes twice the upper limit of normal were excluded from the final analysis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Anaemia was defined &#40;according to WHO criteria&#41; as the presence of haemoglobin levels &#60;13<span class="elsevierStyleHsp" style=""></span>g&#47;dL in males and &#60;12<span class="elsevierStyleHsp" style=""></span>g&#47;dL in females&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Sample Size</span><p id="par0055" class="elsevierStylePara elsevierViewall">The following data were taken into account for calculating the sample size&#58; 80&#37; of patients with COPD and anaemia have high inflammatory markers and 20&#37; of patients with COPD without anaemia also have them&#46; Therefore&#44; 17 patients would have to be included in each group for a 95&#37; confidence interval and a statistical power of 90&#37;&#46; Considering recent publications that estimate that the prevalence of anaemia in stable COPD is 13&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> a total of 130 patients would have to be included in the study to reach this number of patients in the COPD and anaemia group&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical Analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Equality of means in the variables between patients with and without anaemia was tested using bootstrap analysis&#44; since the samples from individuals with anaemia have an n of between 6 and 8 individuals and&#44; therefore&#44; it is not correct to compare and&#47;or assume the hypothesis of normality&#46; This method was therefore selected&#44; as it does not require the assumption of certain patterns of behaviour&#46; The maximum number of regenerated non-repeat samples is not arbitrary but depends on the sample size&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> In this study&#44; it varied from 300 to 5000 replicates&#44; depending on the number of patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In order to study the correlation between the variables&#44; we used the Kendall Tau-b and Spearman Rho coefficients&#44; non-parametric measures based on ranges&#44; which allow bivariate relationships to be compared&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> A <span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 was considered significant&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS version 19 and&#44; for the bootstrap&#44; &#64;RISK 4&#46;5&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">One hundred and forty-seven patients diagnosed with COPD and under follow-up in outpatients were initially included&#44; of whom 17 were excluded from the final analysis because they presented some of the previously described exclusion criteria&#46; The most common cause of exclusion was renal failure in 6 cases &#40;35&#37;&#41;&#44; followed by absence of COPD diagnosis &#40;5 cases&#44; 29&#46;4&#37;&#41;&#44; abnormal thyroid profile &#40;2 cases&#41; and abnormal folic acid&#47;vitamin B<span class="elsevierStyleInf">12</span> levels &#40;2 cases&#58; one due to abnormal liver profile and the other due to chronic heart failure&#41;&#46; The prevalence of anaemia in COPD patients who were excluded &#40;12&#41; was 16&#46;6&#37;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 130 patients finally included in the study&#44; 8 had anaemia&#44; which represents a prevalence of 6&#46;2&#37;&#46; In all cases&#44; it was defined as normochromic normocytic anaemia with a high coefficient of variation in the mean cell volume&#44; with low iron and normal transferrin and ferritin levels&#46; These data are consistent with anaemia of chronic disease&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The anaemia was mild in most cases&#44; with a mean haemoglobin value of 11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;95<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#46; The main characteristics of patients in our series and the differences in the epidemiological characteristics and analytical data between the group of cases with and without anaemia are shown in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Patients in the anaemia group had a lower BMI &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#44; higher Charlson index &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;002&#41; and higher erythropoietin levels &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;016&#41;&#46; Patients with anaemia had more severe COPD in terms of the post-bronchodilator FEV<span class="elsevierStyleInf">1</span>&#37;&#44; although this did not reach statistical significance &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;08&#41;&#46; There were no differences in the age&#44; sex&#44; smoking history&#44; dyspnoea&#44; quality of life &#40;measured using the EQ-5D&#41;&#44; arterial PaO<span class="elsevierStyleInf">2</span> or PaCO<span class="elsevierStyleInf">2</span> values&#44; exacerbations in the previous year&#44; score in the BODE index or metres covered in the 6-minute walk test between patients with and without anaemia&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The haemoglobin levels showed an inverse correlation with the Charlson index &#40;Kendall&#39;s Tau-b&#61;0&#46;13&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;046&#44; and Spearman&#39;s Rho&#61;0&#46;17&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;044&#41; and with the erythropoietin levels &#40;Kendall&#39;s Tau-b&#61;&#8722;0&#46;15&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;020&#44; and Spearman&#39;s Rho&#61;&#8722;0&#46;21&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;022&#41;&#46; The correlations with the other parameters analysed&#44; including the PaO<span class="elsevierStyleInf">2</span>&#44; PaCO<span class="elsevierStyleInf">2</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#37;&#44; distance covered in the 6-minute walk test&#44; cumulative smoking &#40;pack-years&#41; or BODE index were not significant&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The usual treatment of patients in each group was recorded&#46; Four patients with anaemia were on treatment with angiotensin II receptor blockers compared to 14 patients in the group without anaemia &#40;50&#37; vs 11&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#44; and one patient with anaemia was on treatment with angiotensin-converting-enzyme inhibitors compared to 21 in the group without anaemia &#40;12&#46;5&#37; vs 17&#46;2&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;61&#41;&#46; The prevalence of anaemia in COPD patients not treated with these drugs was 3&#46;3&#37;&#46; Only 6 of the 130 patients were on theophylline treatment&#44; none of whom had anaemia&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the patient distribution according to the degree of obstruction&#58; 8&#46;8&#37; of patients with very severe COPD had anaemia compared to 0&#37; in patients with mild COPD&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the inflammatory markers analysed&#46; The group of patients with anaemia had significantly lower IL-6 values&#44; but no differences were found in the other parameters&#46; A direct correlation was observed between the haemoglobin levels and serum IL-6 levels &#40;Kendall&#39;s Tau-b&#61;0&#46;16&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;018&#44; and Spearman&#39;s Rho&#61;&#8722;0&#46;20&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;021&#41;&#46; Correlations with the other inflammatory parameters analysed were not significant&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our study&#44; the prevalence of anaemia was 6&#46;2&#37;&#44; which is lower than most figures published to date&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;11</span></a> All show a prevalence above 10&#37;&#44; except for those by Watz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and Nowinski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> These differences in prevalence are most likely due to methodological differences between studies&#58; most are retrospective studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> analysis of different populations&#58; stable or exacerbated&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a> outpatients<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;9</span></a> or inpatients<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a>&#59; different definitions of anaemia<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8</span></a>&#59; different grades of obstruction with FEV<span class="elsevierStyleInf">1</span> between 37&#37;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and 56&#37;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#59; and confounding factors included in the analysis&#44; such as heart failure&#44; renal failure or associated neoplasms&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">There are reports that show that the prevalence and severity of anaemia in the general population increase with age and are related with the patient&#39;s underlying condition&#46; Thus&#44; in the study by Guralnik et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> the prevalence of anaemia of unknown cause in the group aged between 50 and 64 years was 4&#46;4&#37; in men and 6&#46;8&#37; in women&#44; while in the group aged between 64 and 74 years it was 7&#46;8&#37; in men and 8&#46;5&#37; in women&#46; These values are similar to those found in our study&#44; where the mean age was 64&#46;2 years &#40;SD&#61;8&#46;4&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The main aim of our study was to determine the prevalence of anaemia not attributable to other causes in COPD patients&#44; and for this reason&#44; cases with other known causes of anaemia&#44; as described in the study methods&#44; were excluded&#46; The Charlson index for the population included in our study is around 2&#46; Of these&#44; 43&#37; of patients had hypertension&#44; 33&#37; hypercholesterolaemia and 16&#37; diabetes mellitus&#46; These data are very similar to those of other studies evaluating the presence of comorbidities in COPD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> This confirms that our sample is a representative population of patients with COPD and their spectrum of the most common comorbidities&#44; since only those that could cause anaemia were excluded&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The anaemia was generally mild &#40;mean haemoglobin values of 11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;95<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41; and its characteristics were consistent with anaemia of chronic disease&#44; similar to other previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;9</span></a> Having applied very strict exclusion criteria&#44; our study suggests that the prevalence of anaemia not attributable to other causes in stable COPD patients is lower than found up to now in the literature&#44; and may be close to the prevalence of anaemia in the general population in the same age range&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Although it did not reach statistical significance&#44; patients with anaemia had a tendency to have more severe COPD in terms of FEV<span class="elsevierStyleInf">1</span>&#44; with a prevalence of anaemia in patients with very severe COPD close to 9&#37;&#46; Most previous studies do not describe a relationship between the prevalence of anaemia and the severity of the COPD&#44; except for the one by Watz et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in which the prevalence of anaemia was higher in patients with very severe COPD &#40;14&#37;&#41;&#44; and that of Boutou et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in which the group with anaemia had a lower FEV<span class="elsevierStyleInf">1</span> than the group without anaemia&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Few studies have analysed the impact of anaemia on patients with COPD&#46; The efficiency of gas exchange depends on haemoglobin levels&#59; if these fall&#44; that exchange and&#44; therefore&#44; the exercise capacity could worsen&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In our study&#44; no differences were observed with respect to the dyspnoea scale&#44; or in metres covered in the 6-minute walk test&#44; unlike two previous studies that analysed these parameters&#44; in which patients with anaemia had a higher grade of dyspnoea and covered less distance in the 6-minute walk test&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Although there is increasing data in relation to the role of systemic inflammation in COPD&#44; few studies mention the physiopathology of COPD-associated anaemia&#46; In theory&#44; this could be similar to other chronic inflammatory diseases&#44; where it has been postulated that its origin could be in an immunological and inflammatory response&#44; mediated by TNF-&#945;&#44; IL-1&#44; IL-6 and interferon gamma&#44; which would generate changes in iron metabolism&#44; reducing its intestinal absorption and altering haematopoiesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;24</span></a> In patients with COPD&#44; there is an increase in these mediators&#44; which could be considered as factors related with the onset of anaemia associated with this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> In our study&#44; the anaemia presented findings consistent with anaemia of chronic disease&#44; and as in two other previous studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;25</span></a> it presented with low iron and significantly higher erythropoietin levels&#44; which support the theory of peripheral resistance to the action of erythropoietin mediated by an inflammatory component&#46; These findings&#44; which are common to other chronic diseases that present with anaemia&#44; are important&#44; as studies have recently been carried out suggesting that the correction of iron deficiency in patients with heart failure could improve their prognosis&#44; thereby opening new therapeutic targets to be studied in the future&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Only one previous paper<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> compared interleukin and CRP values in COPD patients with and without anaemia in relation to healthy controls&#46; In this study&#44; IL-6 and CRP were significantly higher in COPD patients than in controls&#44; with no differences found in the other interleukins &#40;IL-8 and IL-10&#41;&#46; In the COPD group&#44; patients with anaemia had significantly higher CRP values than non-anaemic patients&#44; but no differences were found in the IL-6&#44; IL-8 and IL-10 values&#46; In our study&#44; we found a non-significant increase in CRP levels&#44; and patients with anaemia had significantly lower IL-6 values and a direct correlation between the haemoglobin and IL-6 levels&#46; We did not find a physiopathological explanation for these findings&#44; which should be confirmed in future studies&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Moreover&#44; there are other added factors that influence the erythropoietic response and which also may be present in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Thus&#44; it is known that certain drugs may influence haemoglobin levels&#44; such as angiotensin-converting-enzyme inhibitors and angiotensin II receptor inhibitors&#44; which cause a decrease in haemoglobin and erythropoietin levels&#46; These drugs are often used for the treatment of hypertension and&#44; according to some studies&#44; the prevalence of this condition in COPD patients could be around 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Other treatments&#44; such as theophylline&#44; may also influence erythropoiesis&#44; by a complex mechanism of apoptosis induced by the drug itself&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> In our study&#44; 50&#37; of patients with anaemia were on treatment with angiotensin II receptor blockers compared to 11&#46;5&#37; of the group without anaemia &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#44; although no differences were found in relation to the use of other drugs such as angiotensin-converting-enzyme inhibitors and theophyllines&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Our study is not free of limitations&#44; especially those that could be derived from the sample size or the use of some exclusion criteria not included in previous studies&#44; which could limit the comparison of our data with previously published results&#46; Despite this&#44; our data are interesting&#44; as they show a lower prevalence of COPD-associated anaemia than previously described and open the door to physiopathological theories that could explain the onset of anaemia in these patients&#46; Further studies with larger COPD populations and stricter inclusion criteria are required in order to eliminate confounding factors&#44; and which allow a better understanding of the onset of anaemia in these patients from a physiopathological point of view and of the clinical and prognostic implications&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This study was partially funded by <span class="elsevierStyleGrantSponsor" id="gs0005">GlaxoSmithKline S&#46;A&#46;</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs0005">CRT114268</span>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of Interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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          "titulo" => "Keywords"
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          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Introducci&#243;n"
            2 => "M&#233;todos"
            3 => "Resultados"
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            0 => array:2 [
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              "titulo" => "Sample Size"
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              "titulo" => "Statistical Analysis"
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          "titulo" => "Results"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-02-02"
    "fechaAceptado" => "2013-04-30"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Anaemia"
            1 => "Chronic obstructive pulmonary disease"
            2 => "Prevalence"
            3 => "Interleukin"
            4 => "Erythropoietin"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec254943"
          "palabras" => array:5 [
            0 => "Anemia"
            1 => "Enfermedad pulmonar obstructiva cr&#243;nica"
            2 => "Prevalencia"
            3 => "Interleucinas"
            4 => "Eritropoyetina"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anaemia is one of the extrapulmonary manifestations of chronic obstructive pulmonary disease &#40;COPD&#41;&#46; Its real prevalence&#44; physiopathology and clinical repercussion are unknown&#46; The objectives of our study were&#58; to determine the prevalence of anaemia in patients with stable COPD not attributable to other causes and to establish the relationship of anaemia with clinical&#44; prognostic and inflammatory markers with an important role in COPD&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study included stable COPD patients with no other known causes of anaemia&#46; The following tests were carried out&#58; respiratory function tests&#59; serum determination of erythropoietin and inflammatory markers&#58; high sensitivity <span class="elsevierStyleSmallCaps">C</span>-reactive protein &#40;hs-CRP&#41;&#44; fibrinogen&#44; interleukin 6 &#40;IL-6&#41;&#44; interleukin 8 &#40;IL-8&#41; and tumour necrosis factor &#945; &#40;TNF-&#945;&#41;&#46; Body mass index &#40;BMI&#41;&#44; Charlson and BODE indices&#44; the number of exacerbations in the previous year&#44; dyspnoea and quality of life were also calculated&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">One hundred and thirty patients were included&#46; Anaemia prevalence was 6&#46;2&#37;&#46; Mean haemoglobin value in anaemic patients was 11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;95<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#46; Patients with anaemia had a lower BMI &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#44; higher Charlson index &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;002&#41;&#44; more elevated erythropoietin levels &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;016&#41;&#44; a tendency to present a lower FEV<span class="elsevierStyleInf">1</span>&#37; value &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;08&#41; and significantly lower IL-6 values when compared to non-anaemic patients &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our series&#44; the anaemia associated with COPD was less prevalent than that published in the literature to date&#44; and was related to certain clinical and inflammatory markers&#46;</p>"
      ]
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La anaemia es una de las manifestaciones extrapulmonares de la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41;&#46; Su prevalencia&#44; su fisiopatolog&#237;a y su repercusi&#243;n cl&#237;nica son desconocidas&#46; Los objetivos de nuestro estudio son determinar la prevalencia de la anaemia en pacientes con EPOC en fase estable no atribuible a otras causas y establecer la relaci&#243;n de la anaemia con variables cl&#237;nicas&#44; pron&#243;sticas y marcadores inflamatorios con un papel relevante en la EPOC&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron pacientes con EPOC en fase estable sin otras causas conocidas de anaemia&#46; Se realizaron pruebas de funci&#243;n respiratoria&#44; determinaci&#243;n de eritropoyetina y marcadores inflamatorios s&#233;ricos&#58; PCR ultrasensible &#40;PCR&#41;&#44; fibrin&#243;geno&#44; interleucina 6 &#40;IL-6&#41;&#44; interleucina 8 &#40;IL-8&#41; y factor de necrosis tumoral alfa &#40;TNF-&#945;&#41;&#46; Se registr&#243; el &#237;ndice de masa corporal &#40;IMC&#41;&#44; el &#237;ndice de Charlson y el BODE&#44; el n&#250;mero de exacerbaciones en el a&#241;o previo&#44; la escala de disnea y la calidad de vida&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 130<span class="elsevierStyleHsp" style=""></span>pacientes&#46; La prevalencia de anaemia fue del 6&#44;2&#37;&#46; El valour de hemoglobina en los pacientes con anaemia fue de 11&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;95<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#46; Los pacientes con anaemia ten&#237;an un IMC m&#225;s bajo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; un &#237;ndice de Charlson mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; niveles de eritropoyetina m&#225;s elevados &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; una tendencia a presentar niveles m&#225;s bajos de FEV<span class="elsevierStyleInf">1</span>&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;08&#41; y valores significativamente m&#225;s bajos de IL-6 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41; cuando se comparan con los pacientes no an&#233;micos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En nuestra serie&#44; la anaemia asociada a la EPOC es menos prevalente de lo publicado hasta la actualidad y guarda relaci&#243;n con determinados factores cl&#237;nicos y marcadores inflamatorios&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Comeche Casanova L&#44; et al&#46; Prevalencia de anemia asociada a la enfermedad pulmonar obstructiva cr&#243;nica&#46; Estudio de las variables asociadas&#46; Arch Bronconeumol&#46; 2013&#59;49&#58;383-387&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The values are shown in mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#44; except for gender and treatment with angiotensin II receptor blockers&#44; which are expressed as number of patients and percentage&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Patients without anaemia &#40;n&#61;122&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">57&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">FEV<span class="elsevierStyleInf">1</span>&#47;FVC post BD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PaCO<span class="elsevierStyleInf">2</span>&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyspnoea&#44; mMRC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EQ-5D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EQ5VAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Charlson Index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BODE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Distance covered in the walk test&#44; m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">418&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">375&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>112&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exacerbations in the previous year&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment with angiotensin II receptor blockers&#44; number of patients and &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">General Characteristics of Patients Included in the Study&#46; Differences Between Groups&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">MCHC&#44; mean cell haemoglobin concentration&#59; MCV&#44; mean cell volume&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Values are shown as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients without anaemia &#40;n&#61;122&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with anaemia &#40;n&#61;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haemoglobin&#44; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&#177;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9&#177;0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haematocrit&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;6&#177;3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;8&#177;2&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MCV&#44; fl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;76&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;9&#177;8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MCHC&#44; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;9&#177;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;2&#177;1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Iron&#44; &#956;g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;4&#177;29&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;6&#177;42&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ferritin&#44; ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&#46;6&#177;123&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115&#46;3&#177;148&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transferrin&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256&#46;4&#177;35&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">273&#46;1&#177;62&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Erythropoietin&#44; mU&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&#177;13&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;1&#177;17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;0016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab392501.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Characteristics of Analytical Parameters&#46; Differences Between Groups&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The percentages in each cell correspond to the percentage of patients for each obstruction grade&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grade of obstruction</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mild &#40;n&#61;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Moderate &#40;n&#61;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Severe &#40;n&#61;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Very severe &#40;n&#61;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients without anaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;94&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;94&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;91&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with anaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;8&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab392502.png"
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        ]
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patient Distribution According to Grade of Obstruction&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0020"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The values are shown as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients without anaemia &#40;n&#61;122&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with anaemia &#40;n&#61;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High-sensitivity CRP&#44; mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;1&#177;17&#46;1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;8&#177;26&#46;9 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL-6&#44; pg&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;7&#177;91&#46;4 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;3&#177;5 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IL-8&#44; pg&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;8&#177;72&#46;8 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>120&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;8&#177;21&#46;7 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TNF-&#945;&#44; pg&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&#177;2 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>121&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;1&#177;2&#46;1 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibrinogen&#44; mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">371&#46;4&#177;97&#46;9 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>117&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">424&#46;5&#177;132&#46;5 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab392503.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Blood High-Sensitivity CRP&#44; IL-6&#44; IL-8&#44; TNF-&#945; and Fibrinogen Values&#46; Differences Between Groups&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "From the Global Strategy for the Diagnosis&#44; Management and Prevention of COPD&#44; Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41; Update 2013&#46; Available from&#58; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.goldcopd.org/">http&#58;&#47;&#47;www&#46;goldcopd&#46;org</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systemic manifestations and comorbidities of COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;J&#46; Barnes"
                            1 => "B&#46;R&#46; Celli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00128008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2009"
                        "volumen" => "33"
                        "paginaInicial" => "1165"
                        "paginaFinal" => "1185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19407051"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
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ISSN: 15792129
Original language: English
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