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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic Obstructive Pulmonary Disease &#40;COPD&#41; is a major cause of morbidity and mortality worldwide&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">1&#44;2</span></a> COPD is associated with various comorbidities such as cardiovascular disease&#44; cachexia&#44; osteoporosis&#44; metabolic syndrome&#44; depression&#44; pulmonary hypertension&#44; lung cancer&#44; and anaemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">1&#8211;3</span></a> These comorbidities influence mortality and hospitalizations independently&#44; so should be treated appropriately&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">2&#44;4</span></a> Anaemia is increasingly recognized as an important comorbidity&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">5</span></a> being and independent predictor of dyspnoea&#44; exercise limitation&#44; anaerobic threshold&#44; worse health-related quality of life &#40;QoL&#41;&#44; and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">6&#8211;8</span></a> Beyond anaemia&#44; non-anaemic iron deficiency &#40;NAID&#41; has also been linked to worse clinical outcomes including frequent exacerbations&#44; and predicts exercise intolerance&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">6&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Iron is an essential micronutrient in energy metabolism<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> since it plays a key role in oxygen transport &#40;as part of the ferrous ring of haemoglobin &#40;Hb&#41;&#41;&#44; storage &#40;as a component of myoglobin&#41;&#44; uptake in the oxidative metabolism within the skeletal muscle and in cellular bioenergetics as a whole&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">10&#8211;12</span></a> In other words&#44; cellular oxidative metabolism strongly relies on iron availability&#44; which is indispensable for both sufficient oxygen supply&#44; mitochondrial function&#44; and effective substrate catabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> Furthermore&#44; iron is also involved in erythropoiesis&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">12</span></a> Therefore&#44; an adequate iron homeostasis is crucial for cell activity&#44; especially for those characterized by intensive metabolism and high energy demand&#44; such as skeletal myocytes and cardiomyocytes&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">13</span></a> which are key elements in skeletal muscle and heart functions&#44; respectively&#46; In this regard&#44; iron deficiency &#40;ID&#41; may significantly contribute to the loss of skeletal muscle oxidative capacity seen in patients with chronic heart failure &#40;CHF&#41; and COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> Therefore&#44; peripheral and respiratory muscle dysfunction may occur&#44; constituting a potential pathophysiological link between impaired iron status and decreased exercise capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In recent years&#44; ID with or without anaemia has been studied in pulmonary arterial hypertension &#40;PAH&#41;&#44; CHF&#44; and chronic kidney disease&#44; where it was associated with impaired exercise tolerance and worse clinical outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;13&#44;15</span></a> In a previous investigation from our group&#44; COPD patients with NAID showed lower pre-training aerobic capacity and reduced training-induced response in comparison with those with normal iron status&#44; suggesting that ID hampered pulmonary rehabilitation in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">16</span></a> Surprisingly&#44; even though iron supplementation is associated with clinical benefits in patients with PAH or CHF&#44;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;13&#44;15</span></a> the impact of this therapy in COPD has not been fully elucidated&#46; In the only randomized clinical trial published to date&#44; intravenous iron supplementation did not show any effect on arterial oxygenation&#44; although it increased exercise capacity improving the six-minute walk test &#40;6MWT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The FACE &#40;&#8216;Ferinject Assessment in patients with COPD and iron deficiency to improve Exercise tolerance&#8217;&#41; study was designed to test the hypothesis that&#44; compared to placebo&#44; intravenous iron repletion would improve exercise tolerance in patients with ID&#46; Secondary objectives included the assessment of potential changes in QoL and daily physical activity &#40;DPA&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Trial design</span><p id="par0025" class="elsevierStylePara elsevierViewall">FACE was a single-blind&#44; parallel group&#44; placebo controlled clinical trial conducted in a single tertiary care hospital&#46; Patients included were from January 2018 to January 2020 and were subsequently randomized with a 2&#58;1 sequence to receive a single dose of ferric carboxymaltose or placebo&#46; The study methods have been fully detailed in the supplementary material&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Participants</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Eligibility criteria&#44; recruitment&#44; and follow-up</span><p id="par0030" class="elsevierStylePara elsevierViewall">Eligible participants were adults aged between 45 and 80 years&#44; diagnosed of COPD according to Global Strategy of Management of COPD patients &#40;GOLD&#41; criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">18</span></a> Patients must have shown clinical stability for at least 8 weeks prior to their inclusion in the study&#46; Patients were recruited from primary&#44; secondary and tertiary care settings&#46; ID and mild anaemia definitions are included in the <a class="elsevierStyleCrossRef" href="#sec0105">supplementary material</a>&#46; The study flow chart including the follow-up is summarized in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Patients signed the informed consent that indicated that they had been informed of all pertinent aspects of the trial in visit 1&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Randomization&#44; study therapy and blinding</span><p id="par0035" class="elsevierStylePara elsevierViewall">In visit 2&#44; randomization was performed by a clinical pharmacist according to a computer-generated list following simple randomization procedures to receive either ferric carboxymaltose &#40;Ferinject&#174; 50<span class="elsevierStyleHsp" style=""></span>mg&#47;ml solution for intravenous injection&#44; Vifor&#44; Switzerland&#41; or placebo&#46; Full details of the trial blinding can be found in the <a class="elsevierStyleCrossRef" href="#sec0105">supplementary material</a>&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Outcomes</span><p id="par0040" class="elsevierStylePara elsevierViewall">The primary outcome was the achievement of at least 33&#37; improvement from baseline in the endurance time &#40;ET&#41; obtained during a constant work-rate exercise test &#40;CWRET&#41; using cycle-ergometer&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a> Secondary endpoints included&#58; a COPD Assessment Test &#40;CAT&#41;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">20</span></a> and DPA&#44; evaluated by accelerometry&#46; Conventional laboratory parameters were also performed&#46; The strength of the upper &#40;handgrip&#41; and lower limb &#40;quadriceps maximal velocity contraction&#44; QMVC&#41; muscles was measured at baseline and following treatment in all the study patients&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">21</span></a> All the outcomes were measured at baseline and 4 weeks after treatment administration&#44; and potential clinical adverse events were recorded and reported&#44; including anticipated and unexpected circumstances according to CONSORT extended guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">According to a previous study&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a> to detect at least a 33&#37; &#91;95&#37; confidence interval &#40;CI&#41;&#44; 18&#8211;48&#37;&#93; ET with a two-sided 5&#37; significance level&#44; a statistical power of 80&#37; and a dropout rate of 20&#37;&#44; a sample size of 42 patients &#40;28 in the ferric carboxymaltose group and 14 in the placebo group&#41; was deemed necessary&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the predefined sample size&#44; non-parametric tests were employed to perform the analysis&#46; Exact methods used to compare groups and subgroup analysis were detailed in the <a class="elsevierStyleCrossRef" href="#sec0105">supplementary material</a>&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant in all the analyses&#44; which were performed with the IBM SPSS Statistics 22&#46;0 package &#40;IBM Co&#46;&#44; Armonk&#44; NY&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study flow diagram is detailed in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; Although a total of 200 patients were initially assessed for eligibility&#44; only 74 &#40;37&#46;0&#37;&#41; were randomized &#40;50 in the ferric carboxymaltose group and 24 in the placebo group&#41;&#46; However&#44; five patients discontinued the trial due to a COPD exacerbation and one was lost in the follow-up&#46; Two more patients who did not replace ID were also excluded&#46; Finally&#44; a total of 66 &#40;33&#37;&#41; patients &#91;44 &#40;66&#46;7&#37;&#41; in the ferric carboxymaltose group and 22 &#40;33&#46;3&#37;&#41; in the placebo group&#93; were included in the analysis&#46; Interestingly&#44; from the consecutive 200 patients that were initially evaluated&#44; 40&#46;5&#37; showed ID&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Baseline clinical&#44; demographical&#44; and analytical characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Both groups presented similar baseline characteristics&#44; including in the handgrip and quadriceps strength tests&#46; Median administered ferric carboxymaltose dose was 500 &#40;500&#8211;1000&#41; mg&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Improvement of endurance time following iron replacement</span><p id="par0065" class="elsevierStylePara elsevierViewall">As far as 52&#46;3&#37; of patients improved their ET by 33&#37; in the treatment group compared to only a 18&#46;2&#37; in the placebo group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#59; Relative Risk &#40;RR&#41; 3&#46;12&#44; &#91;95&#37; CI&#44; 1&#46;19&#8211;8&#46;12&#93;&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The absolute difference was 34&#46;1&#37; &#40;95&#37; CI&#44; 10&#46;20&#8211;53&#46;50&#41;&#46; Therefore&#44; the treatment of three patients would achieve the primary endpoint in at least 1 patient&#46; Data on the effects of treatment on ET and other clinical outcomes were shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Regarding the change from baseline in ET&#44; statistically significant differences were found between placebo and ferric carboxymaltose group &#91;119&#46;5 &#40;13&#46;8&#8211;273&#46;3&#41;<span class="elsevierStyleHsp" style=""></span>s vs&#46; &#8722;8&#46;0 &#40;&#8722;50&#46;8&#8211;69&#46;0&#41;<span class="elsevierStyleHsp" style=""></span>s&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;010&#41;&#93;&#46; The inspiratory capacity in the constant work-rate exercise test was assessed in a total of 46 patients &#40;31 in the ferric carboxymaltose group and 15 in the placebo group&#41;&#46; No differences were found after the treatment both in patients treated with intravenous iron &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;542&#41; or placebo &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;875&#41;&#46; Handgrip and quadriceps strength tests were also similar after iron treatment between the two study groups&#58; handgrip strength test &#40;iron group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;000&#44; placebo group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;506&#41; and quadriceps strength test &#40;iron group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;793&#44; placebo group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;952&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">From the 44 patients treated with intravenous iron&#44; 4 &#40;9&#46;1&#37;&#41; presented mild anaemia&#46; These patients ameliorated their ET by 238&#46;0 &#40;78&#46;8&#8211;264&#46;5&#41; s&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;043&#44; all of them achieving the primary endpoint&#46; No differences were found in the change from baseline in ET compared to patients with NAID &#91;238&#46;0 &#40;78&#46;8&#8211;264&#46;5&#41; vs&#46; 103&#46;5 &#40;9&#46;3&#8211;278&#46;0&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;541&#93; or Hb &#91;1&#46;2 &#40;&#8722;0&#46;1&#8211;1&#46;8&#41; vs&#46; 0&#46;5 &#40;&#8722;0&#46;2&#8211;1&#46;2&#41; g&#47;dL&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;383&#93;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Iron status</span><p id="par0075" class="elsevierStylePara elsevierViewall">Analytical parameters before and after treatment or placebo administration were presented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; The administration of intravenous iron resulted in a significant improvement in all the analytical parameters concerned by this ion metabolism &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all comparisons&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Impact of the iron replacement on CAT and DPA</span><p id="par0080" class="elsevierStylePara elsevierViewall">The analysis of these secondary outcomes is summarized in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; There were no statistically significant differences with respect to placebo in the change of the scores of the CAT questionnaire&#46; In patients with mild anaemia treated with intravenous iron&#44; CAT questionnaire improved by &#8722;7&#46;5 &#40;&#8722;16&#46;5&#8211;2&#46;3&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;138&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Post hoc analysis of patients with ferritin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL</span><p id="par0085" class="elsevierStylePara elsevierViewall">The response of patients with ferritin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL to iron therapy was further analyzed and described in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Close to a quarter &#40;22&#46;7&#37;&#41; of patients receiving treatment presented less than 30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL of ferritin&#46; These patients presented a more favourable response&#44; as all of them patients achieved the primary endpoint versus only 38&#46;2&#37; in those with normal ferritin levels &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;77 &#40;95&#37; CI&#44; 1&#46;24&#8211;2&#46;53&#41;&#93;&#46; Overall&#44; these patients improved their endurance time by 101&#46;3&#37; vs&#46; 17&#46;6&#37; in the ferritin<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Furthermore&#44; a trend towards an improvement in the CAT questionnaire was also noticed&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Safety data</span><p id="par0095" class="elsevierStylePara elsevierViewall">No differences were reported between both study groups concerning safety&#46; More specifically&#44; no injection-site pain&#44; discoloration or hypersensitivity reactions were observed after 4 weeks from the treatment&#44; and blood pressure was within normal values throughout the entire course in all patients&#46; Moreover&#44; 6&#46;3&#37; of patients having received treatment presented COPD exacerbation vs&#46; 8&#46;3&#37; in the placebo group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;656&#59; RR&#58; 0&#46;79 &#91;95&#37; CI 0&#46;26&#8211;2&#46;46&#93;&#59; Risk reduction&#58; &#8722;2&#46;33&#37; &#91;95&#37; CI &#8722;15&#46;20&#8211;10&#46;53&#93;&#59; number needed to harm 43 patients&#41; but none of these patients required hospital admission or died&#46; Oral antibiotics were prescribed in two cases and oral corticosteroids were given in the rest&#46; Exacerbation was not considered to be related to the study drug and was defined as grade 2 side effect&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Only one patient did not tolerate the treatment with intravenous iron &#40;2&#46;3&#37;&#44; Risk Reduction&#58; 2&#46;3&#37; &#91;95&#37; CI &#8722;2&#46;13&#8211;6&#46;68&#93;&#59; number needed to harm 46 patients&#41;&#46; This adverse event was considered as grade 1 &#40;mild effect&#59; intervention not indicated&#41; and treatment infusion was continued without further events&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the largest study assessing the impact of the intravenous iron supplementation on exercise tolerance in COPD patients with ID with or without mild anaemia&#46; The main finding of this study was that the treatment with intravenous ferric carboxymaltose was associated with a larger improvement in the endurance time compared to placebo&#44; even in patients without mild anaemia&#46; The results of our study confirm our previous hypothesis and fit with those found in other chronic diseases&#46; Based on our predefined subgroup analysis&#44; we also found that patients with a ferritin value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL performed strikingly better&#46; However&#44; this is only a hypothesis generating data&#46; Finally&#44; iron treatment was well tolerated without significant safety issues&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">ID is estimated to affect two billion people worldwide<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">23</span></a> being the leading cause of anaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">24</span></a> Moreover&#44; ID appears to be responsible for 0&#46;8&#37; of all deaths and 1&#46;3&#37; of all disability-adjusted life years&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">24</span></a> In COPD patients in particular&#44; anaemia and ID are quite common&#46; However&#44; the former is neither sought for or&#44; if found&#44; not treated&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">25</span></a> Furthermore&#44; NAID is observed in almost 40&#8211;50&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">8&#44;26</span></a> The present study shows a NAID prevalence of 40&#37; in a screening of 200 patients&#46; However&#44; although ID and NAID are associated with reduced exercise tolerance and QoL&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">16</span></a> current guidelines of COPD<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">2</span></a> did not recognize these abnormalities as common and clinically relevant comorbidities&#46; In contrast&#44; the 2016 European Society of Cardiology guidelines for the diagnosis and treatment of acute and CHF do recommend ferric carboxymaltose for the treatment of ID to alleviate heart failure symptoms and improve exercise capacity and QoL&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">To date&#44; studies on ID and resultant decreased exercise performance have been performed predominantly in animal models&#44; while data regarding the relationship between ID and skeletal muscle dysfunction in ID anaemic human subjects are limited and inconsistent&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> Furthermore&#44; the benefits of iron replacement have been found in cardiopulmonary diseases other than COPD such as CHF and PAH with ID&#44; with or without anaemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;13&#44;15&#44;29&#8211;32</span></a> In the largest randomized controlled clinical trial including 459 patients with CHF&#44; Anker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">11</span></a> showed that treatment with intravenous ferric carboxymaltose improved symptomatology&#44; functional capacity and QoL with an acceptable safety profile&#46; Similarly&#44; this treatment can also improve clinical outcomes in PAH patients with ID&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">33</span></a> Moreover&#44; Viethen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">32</span></a> studied the treatment with a single dose of &#8804;1000<span class="elsevierStyleHsp" style=""></span>mg of ferric carboxymaltose in 20 patients with pulmonary hypertension and ID&#44; reporting a significant improvement not only in iron status but in the 6MWT distance and QoL&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">While the effort limitation mechanisms in iron deficiency anaemia may also include oxygen transport&#44; when there is NAID&#44; it might be the result of diminished oxygen utilization in the muscle cells due to impaired synthesis or function of different iron-containing enzymes&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">6</span></a> In fact&#44; experimental data from in vitro and animal studies indicate that skeletal muscle network of pathways for energy production is hampered by ID at different points in the distinct metabolic routes&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> ID affects mitochondrial morphology &#40;such as a decrease in density of cristae in the mitochondrial inner membrane&#41; and dramatically impairs the process of mitochondrial oxidative phosphorylation&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> All these effects may add to the general decrease in oxidative metabolism efficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> This is one of the hypotheses by which NAID may have a negative impact on aerobic capacity<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">16</span></a> and can produce fatigue and exercise intolerance<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">34</span></a> in patients with demonstrated peripheral muscle dysfunction&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">9&#44;35</span></a> On the other hand&#44; it should be mentioned that peripheral muscle strength did not improve following treatment with iron in any of the study groups&#46; These results suggest that factors other than muscle function are major contributors to general exercise tolerance in severe COPD patients&#44; as has been shown in previous reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">36&#8211;39</span></a> As such&#44; it has been demonstrated a mismatch between ventilatory capacity and the patients&#8217; demand&#44; an imbalance between energy requirements and supply to the working respiratory and peripheral muscles&#44; and other factors that contribute to muscle dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">37</span></a> The effects of iron supplementation may go beyond those of skeletal muscle performance&#46; Organs such as the vascular endothelium&#44; myocardium&#44; and the lungs and airways may have also contributed to the improvement in ET seen in the patients who received iron replacement&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">36&#8211;39</span></a> Another interesting possibility is the decrease in myoglobin reserves in the muscle&#44; which would affect its bioenergetics&#46; As Hb&#44; myoglobin is an iron- and -oxygen binding protein&#46; Its function is not completely elucidated but it is believed that it also participates in oxygen storage within the muscle increasing the availability of this gas for aerobic purposes&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">40</span></a> On the other hand&#44; myoglobin as Hb are scavengers of reactive oxygen species&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">41</span></a> This would limit oxidative stress&#44; one of the mechanisms involved in muscle dysfunction repeatedly observed in COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">42</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Considering all this evidence&#44; it is not surprising that in the aforementioned randomized clinical trial conducted in patients with CHF&#44; the treatment with ferric carboxymaltose was beneficial to both patients with anaemia and those without anaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">11</span></a> Our study clearly shows similar results in moderate to severe COPD patients either with mild anaemia or NAID&#46; This suggests that the presence of ID is a valid independent therapeutic target in different chronic diseases&#46; We hypothesize that iron availability in skeletal muscles could have improved their oxidative capacity&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">14</span></a> increasing the time to the anaerobic threshold during submaximal exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">31</span></a> The only previous clinical trial analysing the impact of intravenous iron in COPD was recently published by Santer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">17</span></a> Their primary endpoint &#40;oxygen saturation&#41; was not met although exercise capacity &#40;assessed by the 6MWT&#41; improved&#46; However&#44; this might be explained by the fact that patients&#8217; baseline oxygen saturation was only marginally &#40;&#60;1&#37;&#41; lower than that of age-matched general population&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">17</span></a> The exact mechanisms leading to anaemia and ID in COPD are complex and remain not fully understood&#46; Moreover&#44; iron metabolism in patients with this and other chronic illness merits a more detailed investigation to better unravel the reasons why the correction of ID can result in symptomatic improvements even in the absence of changes in Hb&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Interestingly&#44; we have also observed that the improvement in exercise capacity was especially important in those patients with ferritin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">24&#44;43</span></a> This is probably related to the main functions of this protein&#44; which are iron storage&#44; transportation&#44; and delivery to the tissues&#46; However&#44; our finding deserves further studies to completely understand the mechanisms of such a higher improvement&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our study achieves the primary endpoint showing a 3-fold possibility of a 33&#37; improvement in the endurance time with iron treatment when compared to placebo administration&#46; Although this specific improvement &#40;33&#37;&#41; was defined by the European Respiratory Society task force for nonpharmacological interventions&#44;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">44</span></a> we strongly believe that it should be also valid for pharmacological treatments&#46; On the other hand&#44; the election of the endurance time during CWRET as the primary endpoint was based on the previous use of this variable as the outcome measure in other studies&#44; including those using ferric carboxymaltose&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">19&#44;45</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding the secondary endpoints of the present study&#44; we also observed an improvement in CAT questionnaire in those patients who received ferric carboxymaltose&#46; However&#44; DPA did not change&#46; Our hypothesis for this latter result is that all patients were sedentary&#44; and changes in this dimension normally also involve a behavioural intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">46</span></a></p><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Study critique</span><p id="par0145" class="elsevierStylePara elsevierViewall">Vitamin B12 and folic acid play an important role in the synthesis of haemoglobin and are essential in the homocysteine&#44; mitochondrial&#44; muscle metabolism and haematopoiesis&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">47</span></a> This is a relevant issue as previous results showed that up to 34&#46;4&#37; of COPD patients may exhibit vitamin B12 deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">47</span></a> However&#44; in our cohort&#44; both patients with NAID and mild anaemia presented mean corpuscular volume within normal ranges &#40;&#60;100<span class="elsevierStyleHsp" style=""></span>fl&#41;&#44; thus ruling out the possibility that macrocytic anaemia due to vitamin B12 deficiency may have played any role in the reported findings&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A potential limitation may be related to the lack of maximal inspiratory pressure &#40;PImax&#41; measurements in the study patients&#46; Despite the potential interest of this aspect&#44; the study aimed to assess whether treatment with iron may improve exercise tolerance in COPD patients and eventually DPA&#46; Thus&#44; the focus was rather on peripheral limb muscles than on respiratory muscles&#46; Furthermore&#44; PImax does not necessarily predict the patients&#8217; performance on the cardiopulmonary exercise test&#44; which may limit its usefulness in this setting&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">48</span></a> On the other hand&#44; inspiratory muscle weakness was independently associated with skeletal muscle mass in men with systolic chronic heart failure and ID&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">49</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">It should also be mentioned that mechanisms other than the potential contribution of peripheral muscle dysfunction to exercise tolerance may exist&#46; Alterations in vascular lung homeostasis&#44; namely the reversal of haemodynamic and pulmonary vascular remodelling by iron replacement may have also influenced the results&#44; as also shown to occur in a mouse model of NAID&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">50</span></a> Moreover&#44; intracellular iron deficiency within the pulmonary arterial smooth muscle cells also altered lung vascular function&#44; as demonstrated in another mouse model&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">51</span></a> Despite the relevance of these findings&#44; the current clinical trial was not designed to target these aspects in the cohort of COPD patients&#46; Future studies should be specifically designed to address these relevant questions&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Other limitations should be considered such as the fact that only 4 patients in the subgroup with mild anaemia received carboxymaltose&#46; Although the increase in haemoglobin levels could be involved in the improvement of exercise capacity&#44; the small numbers preclude the analysis of the impact of haemoglobin on the study outcomes&#46; Finally&#44; it should be mentioned that this was a single-blind clinical trial and that the trial was conducted only in one centre&#44; which may question the potential extrapolation of the study results to the general population of COPD patients&#46; However&#44; the current results will contribute to the design of multicentric randomized clinical trials soon&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">The FACE study has shown that intravenous iron carboxymaltose therapy is well tolerated and associated with improvements in exercise tolerance and symptoms in patients with COPD and iron deficiency&#44; with or without anaemia&#46; These benefits were even more evident in patients with low ferritin levels&#46; The assessment of the iron profile and correction of iron status may therefore become part of the follow-up and management of COPD patients&#46; Further studies will answer several unsolved questions such as the potential underlying molecular mechanisms&#44; the long-term benefits of the treatment&#44; and the needs for more infusions&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">This study has been funded by Instituto de Salud Carlos-III &#40;ISCIII&#41;&#44; contract grants FIS 17&#47;00649 and 18&#47;00075 &#91;FEDER&#93;&#41;&#44; BA 17&#47;00025&#46; CIBERES&#44; ESF02&#47;2017&#59; Spanish Respiratory Society &#40;SEPAR&#41; 409&#47;2017&#59; Catalan Foundation of Pulmonology &#40;FUCAP&#41; 2017&#59; and an unrestricted grant from Vifor Pharma 2018&#46; Vifor Pharma did not have any role in the study or statistical analyses&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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              "titulo" => "Improvement of endurance time following iron replacement"
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              "titulo" => "Iron status"
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              "titulo" => "Impact of the iron replacement on CAT and DPA"
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              "titulo" => "Post hoc analysis of patients with ferritin &#60; 30 ng&#47;mL"
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    "fechaRecibido" => "2021-03-11"
    "fechaAceptado" => "2021-08-08"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec1612454"
          "palabras" => array:6 [
            0 => "Non-anaemic iron deficiency"
            1 => "Chronic obstructive pulmonary disease"
            2 => "Exercise limitation"
            3 => "Aerobic capacity"
            4 => "Intravenous iron"
            5 => "Quality of life"
          ]
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        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1612453"
          "palabras" => array:15 [
            0 => "6MWT"
            1 => "CAT"
            2 => "CHF"
            3 => "COPD"
            4 => "CWRET"
            5 => "DPA"
            6 => "ET"
            7 => "FACE"
            8 => "Hb"
            9 => "ID"
            10 => "NAID"
            11 => "PAH"
            12 => "PImax"
            13 => "QMVC"
            14 => "QoL"
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    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Iron deficiency affects exercise capacity because of the critical role iron plays in the optimal functioning of skeletal muscle metabolism&#46; We hypothesized that intravenous iron may improve exercise tolerance&#44; quality of life &#40;QoL&#41;&#44; and daily physical activity &#40;DPA&#41; in patients with chronic obstructive pulmonary disease &#40;COPD&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This was a placebo-controlled&#44; single-blind&#44; parallel-group&#44; randomized clinical trial&#46; Iron deficiency was defined as a ferritin level<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ng&#47;mL or a ferritin level between 100 and 299<span class="elsevierStyleHsp" style=""></span>ng&#47;mL with a transferrin saturation<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20&#37;&#44; with or without mild anaemia&#46; Patients were randomized at a 2&#58;1 ratio to receive intravenous ferric carboxymaltose or placebo&#46; The primary objective was to investigate whether intravenous iron replacement improved endurance time from baseline by at least 33&#37;&#46; The secondary objectives were to evaluate impact on QoL using the COPD Assessment Test &#40;CAT&#41; and on DPA by accelerometry&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We included 66 patients&#44; 44 &#40;66&#46;7&#37;&#41; in the intervention group and 22 &#40;33&#46;3&#37;&#41; in the placebo group&#46; Among patients receiving ferric carboxymaltose&#44; 23 &#40;52&#46;3&#37;&#41; achieved the primary endpoint compared to 4 &#40;18&#46;2&#37;&#41; in the placebo group &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#59; relative risk 3&#46;12&#44; &#40;95&#37; CI&#44; 1&#46;19&#8211;8&#46;12&#41;&#93;&#46; CAT score decreased &#8722;3 &#40;&#8722;6&#46;0&#8211;1&#46;3&#41; points from baseline in the intervention group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#44; in contrast to placebo group &#91;&#8722;1 &#40;&#8722;4&#46;0&#8211;2&#46;3&#41; points&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;236&#93; with no differences in DPA and adverse events in both groups&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Iron replacement improved exercise capacity and QoL in stable COPD patients with iron deficiency&#46; The treatment was well tolerated&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Clinical Trial registration</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">EudraCT 2016-001238-89&#46;</p></span>"
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            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Study flow-chart&#46; PFTs&#58; Pulmonary Functional Tests&#59; ECG&#58; electrocardiography&#59; 6MWT&#58; 6-minute walk test&#59; IET&#58; incremental exercise test&#59; CWRET&#58; constant work-rate exercise test&#59; CAT&#58; COPD Assessment Test&#59; FCM&#58; ferric carboxymaltose&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of FACE &#40;Ferinject Assessment in patients with COPD and iron deficiency to improve Exercise tolerance&#41; study according to CONSORT guidelines&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Data are presented as median &#40;Q1&#8211;Q3&#41; or as absolute number &#40;percentage&#41;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; FFMI&#44; fat free mass index&#59; Glomerular filtration rate was calculated by Chronic Kidney Disease Epidemiology Collaboration&#59; ESR&#44; erythrocyte sedimentation rate&#59; MCV&#44; mean corpuscular &#40;erythrocyte&#41; volume&#59; MCH&#44; mean corpuscular haemoglobin&#59; MCHC&#44; mean corpuscular haemoglobin concentration&#59; FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in 1 s&#59; FVC&#44; forced vital capacity&#59; TLC&#44; total lung capacity&#59; DL<span class="elsevierStyleInf">CO</span>&#44; carbon monoxide diffusion capacity corrected for haemoglobin concentration&#59; PaO<span class="elsevierStyleInf">2</span>&#44; oxygen partial pressure&#59; PaCO<span class="elsevierStyleInf">2</span>&#44; carbon dioxide partial pressure&#59; peak V&#8242;O<span class="elsevierStyleInf">2</span>&#44; peak oxygen uptake&#59; RQ max&#44; maximum respiratory quotient&#59; V&#8242;E max&#44; maximum minute ventilation&#59; HR max&#44; maximum heart rate&#59; V&#8242;O<span class="elsevierStyleInf">2</span>&#47;HR&#44; oxygen pulse&#59; AT&#44; anaerobic threshold&#59; V&#8242;E&#47;V&#8242;CO<span class="elsevierStyleInf">2</span>&#44; ventilatory equivalent for carbon dioxide&#59; LAMA&#44; long-acting antimuscarinic antagonists&#59; LABA&#44; long-acting beta<span class="elsevierStyleInf">2</span>-agonists&#59; ICS&#44; inhaled corticosteroid&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Mediterranean diet&#58; according to the questionnaire performed by Spanish Society of Obesity&#44; available in <span class="elsevierStyleInterRef" id="intr0005" href="https://www.seedo.es/index.php/pacientes/dieta-mediterranea">https&#58;&#47;&#47;www&#46;seedo&#46;es&#47;index&#46;php&#47;pacientes&#47;dieta-mediterranea</span>&#46; Date last updated&#58; December 15&#44; 2020&#46; Date last accessed&#58; December 15&#44; 2020&#46;</p>"
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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">9 &#40;40&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pack-years&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">47&#46;5 &#40;32&#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">45&#46;0 &#40;25&#46;0&#8211;80&#46;0&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mediterranean diet questionnaire</span>&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;5 &#40;6&#46;0&#8211;9&#46;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">9&#46;0 &#40;7&#46;0&#8211;10&#46;0&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Medical history</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&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">20 &#40;45&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;59&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus type II&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">8 &#40;18&#46;2&#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">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyslipidaemia&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">19 &#40;43&#46;2&#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">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&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;6&#46;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">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ischaemic cardiomyopathy&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;9&#46;1&#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;9&#46;1&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Charlson comorbidity index</span>&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&#46;0 &#40;3&#46;3&#8211;5&#46;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">4&#46;0 &#40;3&#46;0&#8211;5&#46;0&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory analysis</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinine&#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">0&#46;86 &#40;0&#46;7&#8211;1&#46;04&#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">0&#46;9 &#40;0&#46;7&#8211;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estimated glomerular filtration rate&#44; mL&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&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">82&#46;5 &#40;68&#46;4&#8211;95&#46;0&#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">83&#46;5 &#40;68&#46;3&#8211;90&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total protein&#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">6&#46;9 &#40;6&#46;7&#8211;7&#46;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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;9 &#40;6&#46;6&#8211;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Albumin&#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">4&#46;5 &#40;4&#46;3&#8211;4&#46;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">4&#46;5 &#40;4&#46;2&#8211;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C-reactive protein&#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">0&#46;2 &#40;0&#46;1&#8211;0&#46;3&#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">0&#46;3 &#40;0&#46;1&#8211;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ESR&#44; mm&#47;h&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">8&#46;5 &#40;4&#46;5&#8211;12&#46;0&#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;5 &#40;2&#46;8&#8211;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">386&#46;5 &#40;313&#46;5&#8211;430&#46;3&#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">382&#46;5 &#40;339&#46;5&#8211;480&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vitamin D&#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">11&#46;5 &#40;9&#46;0&#8211;19&#46;0&#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">14&#46;0 &#40;7&#46;8&#8211;28&#46;8&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Iron status</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">14&#46;4 &#40;13&#46;7&#8211;15&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0 &#40;13&#46;9&#8211;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">43&#46;9 &#40;40&#46;9&#8211;46&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;6 &#40;41&#46;2&#8211;47&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">90&#46;7 &#40;88&#46;3&#8211;92&#46;9&#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">90&#46;6 &#40;86&#46;8&#8211;93&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MCH&#44; pg&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">30&#46;2 &#40;29&#46;1&#8211;31&#46;2&#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">30&#46;1 &#40;29&#46;0&#8211;31&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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;1 &#40;32&#46;5&#8211;33&#46;9&#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">33&#46;2 &#40;32&#46;5&#8211;33&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum 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">77&#46;0 &#40;56&#46;7&#8211;109&#46;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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;4 &#40;54&#46;5&#8211;108&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">56&#46;5 &#40;31&#46;5&#8211;87&#46;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">60&#46;5 &#40;36&#46;8&#8211;93&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Transferrin saturation&#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">20&#46;7 &#40;15&#46;2&#8211;28&#46;1&#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">20&#46;2 &#40;15&#46;4&#8211;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Transferrin&#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">278&#46;0 &#40;245&#46;5&#8211;308&#46;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">264&#46;5 &#40;245&#46;0&#8211;287&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Soluble transferrin receptor&#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">2&#46;9 &#40;2&#46;1&#8211;3&#46;2&#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&#46;0 &#40;2&#46;1&#8211;3&#46;4&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pulmonary function</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; 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">1&#46;3 &#40;1&#46;0&#8211;1&#46;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">1&#46;2 &#40;0&#46;9&#8211;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; &#37; predicted&#46;&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">55&#46;0 &#40;41&#46;0&#8211;60&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;38&#46;5&#8211;54&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FVC&#44; 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">2&#46;7 &#40;2&#46;1&#8211;3&#46;2&#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&#46;9 &#40;2&#46;5&#8211;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FVC&#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">80&#46;5 &#40;71&#46;0&#8211;89&#46;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">83&#46;5 &#40;76&#46;0&#8211;93&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#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">49&#46;4 &#40;41&#46;5&#8211;57&#46;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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;2 &#40;34&#46;5&#8211;50&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TLC&#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">111&#46;5 &#40;100&#46;0&#8211;119&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&#46;0 &#40;100&#46;3&#8211;120&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DL<span class="elsevierStyleInf">CO</span>&#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">53&#46;0 &#40;42&#46;3&#8211;62&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;0 &#40;42&#46;8&#8211;60&#46;3&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Post-bronchodilator</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; &#37; predicted&#46;&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">59&#46;0 &#40;46&#46;3&#8211;67&#46;0&#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">49&#46;5 &#40;41&#46;8&#8211;62&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#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">51&#46;5 &#40;41&#46;6&#8211;59&#46;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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;7 &#40;35&#46;7&#8211;53&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FVC&#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">82&#46;0 &#40;77&#46;0&#8211;94&#46;0&#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">88&#46;5 &#40;79&#46;0&#8211;100&#46;0&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Arterial blood gases</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;6 &#40;69&#46;5&#8211;82&#46;7&#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">81&#46;0 &#40;74&#46;2&#8211;82&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;5 &#40;36&#46;5&#8211;40&#46;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">37&#46;3 &#40;35&#46;1&#8211;41&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SaO<span class="elsevierStyleInf">2</span>&#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">95&#46;0 &#40;93&#46;0&#8211;96&#46;0&#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">95&#46;0 &#40;94&#46;0&#8211;96&#46;5&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiopulmonary exercise testing</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peak Load&#44; W&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">68&#46;5 &#40;53&#46;0&#8211;80&#46;0&#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">73&#46;0 &#40;46&#46;8&#8211;87&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peak Load&#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">66&#46;0 &#40;48&#46;0&#8211;91&#46;0&#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">72&#46;0 &#40;54&#46;0&#8211;83&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peak V&#8242;O<span class="elsevierStyleInf">2</span>&#47;kg&#44; ml&#47;min&#47;kg&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;6 &#40;13&#46;0&#8211;19&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;9 &#40;12&#46;6&#8211;17&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peak V&#8242;O<span class="elsevierStyleInf">2</span>&#44; &#37; predicted&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">70&#46;5 &#40;50&#46;5&#8211;93&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;0 &#40;60&#46;5&#8211;81&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RQ max&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">1&#46;1 &#40;1&#46;0&#8211;1&#46;2&#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">1&#46;2 &#40;1&#46;1&#8211;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;E max&#44; l&#47;min&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">40&#46;3 &#40;30&#46;1&#8211;46&#46;9&#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">39&#46;5 &#40;31&#46;6&#8211;52&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;E max&#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">68&#46;0 &#40;54&#46;0&#8211;84&#46;0&#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">69&#46;0 &#40;56&#46;8&#8211;82&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HR max&#44; l&#47;min&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">130&#46;5 &#40;115&#46;3&#8211;140&#46;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">120&#46;1 &#40;111&#46;8&#8211;131&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HR max&#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">82&#46;0 &#40;75&#46;5&#8211;89&#46;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">81&#46;5 &#40;74&#46;0&#8211;84&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;O<span class="elsevierStyleInf">2</span>&#47;HR max&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">8&#46;0 &#40;6&#46;2&#8211;9&#46;2&#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">8&#46;7 &#40;6&#46;5&#8211;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;O<span class="elsevierStyleInf">2</span>&#47;HR max&#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">82&#46;0 &#40;65&#46;5&#8211;89&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;0 &#40;73&#46;0&#8211;102&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oxygen desaturation&#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">0 &#40;0&#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">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;O<span class="elsevierStyleInf">2</span> at AT&#44; ml&#47;min&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">677&#46;5 &#40;548&#46;0&#8211;786&#46;3&#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">551&#46;0 &#40;415&#46;0&#8211;694&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;O<span class="elsevierStyleInf">2</span> at AT&#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">52&#46;0 &#40;45&#46;0&#8211;61&#46;3&#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">44&#46;0 &#40;38&#46;0&#8211;49&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;E&#47;V&#8242;CO<span class="elsevierStyleInf">2</span> at AT&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&#46;0 &#40;32&#46;0&#8211;40&#46;0&#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">37&#46;0 &#40;33&#46;5&#8211;41&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperinsuflation&#44; 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">420&#46;0 &#40;277&#46;5&#8211;562&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">385&#46;0 &#40;0&#46;0&#8211;500&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Final systemic blood pressure&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">190&#46;0 &#40;180&#46;3&#8211;203&#46;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
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LABA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LAMA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ICS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LABA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ICS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LAMA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>LABA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ICS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  """
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                  \t\t\t\t">114&#46;0 &#40;103&#46;0&#8211;127&#46;5&#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">0&#46;017&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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Original Article
Intravenous Iron Replacement Improves Exercise Tolerance in COPD: A Single-Blind Randomized Trial
Clara Martín-Ontiyueloa,b, Anna Rodó-Pina, Daniel Echeverría-Esnalc,d, Mireia Admetllóa, Xavier Duran-Jordàe, Mariela Alvaradoa, Joaquim Geaa,b, Esther Barreiroa,b,1, Diego A. Rodríguez-Chiaradíaa,b,1,
Corresponding author
darodriguez@parcdesalutmar.cat

Corresponding author.
a Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Hospital del Mar-IMIM (Parc de Salut Mar), Health and Experimental Sciences Department (DCEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
b Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos-III (ISCIII), Barcelona, Spain
c Pharmacy Department, Hospital del Mar (Parc de Salut Mar), Barcelona, Spain
d Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
e Methodology & Biostatistics Support Unit, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic Obstructive Pulmonary Disease &#40;COPD&#41; is a major cause of morbidity and mortality worldwide&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">1&#44;2</span></a> COPD is associated with various comorbidities such as cardiovascular disease&#44; cachexia&#44; osteoporosis&#44; metabolic syndrome&#44; depression&#44; pulmonary hypertension&#44; lung cancer&#44; and anaemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">1&#8211;3</span></a> These comorbidities influence mortality and hospitalizations independently&#44; so should be treated appropriately&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">2&#44;4</span></a> Anaemia is increasingly recognized as an important comorbidity&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">5</span></a> being and independent predictor of dyspnoea&#44; exercise limitation&#44; anaerobic threshold&#44; worse health-related quality of life &#40;QoL&#41;&#44; and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">6&#8211;8</span></a> Beyond anaemia&#44; non-anaemic iron deficiency &#40;NAID&#41; has also been linked to worse clinical outcomes including frequent exacerbations&#44; and predicts exercise intolerance&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">6&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Iron is an essential micronutrient in energy metabolism<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> since it plays a key role in oxygen transport &#40;as part of the ferrous ring of haemoglobin &#40;Hb&#41;&#41;&#44; storage &#40;as a component of myoglobin&#41;&#44; uptake in the oxidative metabolism within the skeletal muscle and in cellular bioenergetics as a whole&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">10&#8211;12</span></a> In other words&#44; cellular oxidative metabolism strongly relies on iron availability&#44; which is indispensable for both sufficient oxygen supply&#44; mitochondrial function&#44; and effective substrate catabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> Furthermore&#44; iron is also involved in erythropoiesis&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">12</span></a> Therefore&#44; an adequate iron homeostasis is crucial for cell activity&#44; especially for those characterized by intensive metabolism and high energy demand&#44; such as skeletal myocytes and cardiomyocytes&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">13</span></a> which are key elements in skeletal muscle and heart functions&#44; respectively&#46; In this regard&#44; iron deficiency &#40;ID&#41; may significantly contribute to the loss of skeletal muscle oxidative capacity seen in patients with chronic heart failure &#40;CHF&#41; and COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> Therefore&#44; peripheral and respiratory muscle dysfunction may occur&#44; constituting a potential pathophysiological link between impaired iron status and decreased exercise capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In recent years&#44; ID with or without anaemia has been studied in pulmonary arterial hypertension &#40;PAH&#41;&#44; CHF&#44; and chronic kidney disease&#44; where it was associated with impaired exercise tolerance and worse clinical outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;13&#44;15</span></a> In a previous investigation from our group&#44; COPD patients with NAID showed lower pre-training aerobic capacity and reduced training-induced response in comparison with those with normal iron status&#44; suggesting that ID hampered pulmonary rehabilitation in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">16</span></a> Surprisingly&#44; even though iron supplementation is associated with clinical benefits in patients with PAH or CHF&#44;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;13&#44;15</span></a> the impact of this therapy in COPD has not been fully elucidated&#46; In the only randomized clinical trial published to date&#44; intravenous iron supplementation did not show any effect on arterial oxygenation&#44; although it increased exercise capacity improving the six-minute walk test &#40;6MWT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The FACE &#40;&#8216;Ferinject Assessment in patients with COPD and iron deficiency to improve Exercise tolerance&#8217;&#41; study was designed to test the hypothesis that&#44; compared to placebo&#44; intravenous iron repletion would improve exercise tolerance in patients with ID&#46; Secondary objectives included the assessment of potential changes in QoL and daily physical activity &#40;DPA&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Trial design</span><p id="par0025" class="elsevierStylePara elsevierViewall">FACE was a single-blind&#44; parallel group&#44; placebo controlled clinical trial conducted in a single tertiary care hospital&#46; Patients included were from January 2018 to January 2020 and were subsequently randomized with a 2&#58;1 sequence to receive a single dose of ferric carboxymaltose or placebo&#46; The study methods have been fully detailed in the supplementary material&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Participants</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Eligibility criteria&#44; recruitment&#44; and follow-up</span><p id="par0030" class="elsevierStylePara elsevierViewall">Eligible participants were adults aged between 45 and 80 years&#44; diagnosed of COPD according to Global Strategy of Management of COPD patients &#40;GOLD&#41; criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">18</span></a> Patients must have shown clinical stability for at least 8 weeks prior to their inclusion in the study&#46; Patients were recruited from primary&#44; secondary and tertiary care settings&#46; ID and mild anaemia definitions are included in the <a class="elsevierStyleCrossRef" href="#sec0105">supplementary material</a>&#46; The study flow chart including the follow-up is summarized in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Patients signed the informed consent that indicated that they had been informed of all pertinent aspects of the trial in visit 1&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Randomization&#44; study therapy and blinding</span><p id="par0035" class="elsevierStylePara elsevierViewall">In visit 2&#44; randomization was performed by a clinical pharmacist according to a computer-generated list following simple randomization procedures to receive either ferric carboxymaltose &#40;Ferinject&#174; 50<span class="elsevierStyleHsp" style=""></span>mg&#47;ml solution for intravenous injection&#44; Vifor&#44; Switzerland&#41; or placebo&#46; Full details of the trial blinding can be found in the <a class="elsevierStyleCrossRef" href="#sec0105">supplementary material</a>&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Outcomes</span><p id="par0040" class="elsevierStylePara elsevierViewall">The primary outcome was the achievement of at least 33&#37; improvement from baseline in the endurance time &#40;ET&#41; obtained during a constant work-rate exercise test &#40;CWRET&#41; using cycle-ergometer&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a> Secondary endpoints included&#58; a COPD Assessment Test &#40;CAT&#41;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">20</span></a> and DPA&#44; evaluated by accelerometry&#46; Conventional laboratory parameters were also performed&#46; The strength of the upper &#40;handgrip&#41; and lower limb &#40;quadriceps maximal velocity contraction&#44; QMVC&#41; muscles was measured at baseline and following treatment in all the study patients&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">21</span></a> All the outcomes were measured at baseline and 4 weeks after treatment administration&#44; and potential clinical adverse events were recorded and reported&#44; including anticipated and unexpected circumstances according to CONSORT extended guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">According to a previous study&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a> to detect at least a 33&#37; &#91;95&#37; confidence interval &#40;CI&#41;&#44; 18&#8211;48&#37;&#93; ET with a two-sided 5&#37; significance level&#44; a statistical power of 80&#37; and a dropout rate of 20&#37;&#44; a sample size of 42 patients &#40;28 in the ferric carboxymaltose group and 14 in the placebo group&#41; was deemed necessary&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">19</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the predefined sample size&#44; non-parametric tests were employed to perform the analysis&#46; Exact methods used to compare groups and subgroup analysis were detailed in the <a class="elsevierStyleCrossRef" href="#sec0105">supplementary material</a>&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant in all the analyses&#44; which were performed with the IBM SPSS Statistics 22&#46;0 package &#40;IBM Co&#46;&#44; Armonk&#44; NY&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study flow diagram is detailed in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; Although a total of 200 patients were initially assessed for eligibility&#44; only 74 &#40;37&#46;0&#37;&#41; were randomized &#40;50 in the ferric carboxymaltose group and 24 in the placebo group&#41;&#46; However&#44; five patients discontinued the trial due to a COPD exacerbation and one was lost in the follow-up&#46; Two more patients who did not replace ID were also excluded&#46; Finally&#44; a total of 66 &#40;33&#37;&#41; patients &#91;44 &#40;66&#46;7&#37;&#41; in the ferric carboxymaltose group and 22 &#40;33&#46;3&#37;&#41; in the placebo group&#93; were included in the analysis&#46; Interestingly&#44; from the consecutive 200 patients that were initially evaluated&#44; 40&#46;5&#37; showed ID&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Baseline clinical&#44; demographical&#44; and analytical characteristics are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Both groups presented similar baseline characteristics&#44; including in the handgrip and quadriceps strength tests&#46; Median administered ferric carboxymaltose dose was 500 &#40;500&#8211;1000&#41; mg&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Improvement of endurance time following iron replacement</span><p id="par0065" class="elsevierStylePara elsevierViewall">As far as 52&#46;3&#37; of patients improved their ET by 33&#37; in the treatment group compared to only a 18&#46;2&#37; in the placebo group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#59; Relative Risk &#40;RR&#41; 3&#46;12&#44; &#91;95&#37; CI&#44; 1&#46;19&#8211;8&#46;12&#93;&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The absolute difference was 34&#46;1&#37; &#40;95&#37; CI&#44; 10&#46;20&#8211;53&#46;50&#41;&#46; Therefore&#44; the treatment of three patients would achieve the primary endpoint in at least 1 patient&#46; Data on the effects of treatment on ET and other clinical outcomes were shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Regarding the change from baseline in ET&#44; statistically significant differences were found between placebo and ferric carboxymaltose group &#91;119&#46;5 &#40;13&#46;8&#8211;273&#46;3&#41;<span class="elsevierStyleHsp" style=""></span>s vs&#46; &#8722;8&#46;0 &#40;&#8722;50&#46;8&#8211;69&#46;0&#41;<span class="elsevierStyleHsp" style=""></span>s&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;010&#41;&#93;&#46; The inspiratory capacity in the constant work-rate exercise test was assessed in a total of 46 patients &#40;31 in the ferric carboxymaltose group and 15 in the placebo group&#41;&#46; No differences were found after the treatment both in patients treated with intravenous iron &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;542&#41; or placebo &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;875&#41;&#46; Handgrip and quadriceps strength tests were also similar after iron treatment between the two study groups&#58; handgrip strength test &#40;iron group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;000&#44; placebo group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;506&#41; and quadriceps strength test &#40;iron group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;793&#44; placebo group <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;952&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">From the 44 patients treated with intravenous iron&#44; 4 &#40;9&#46;1&#37;&#41; presented mild anaemia&#46; These patients ameliorated their ET by 238&#46;0 &#40;78&#46;8&#8211;264&#46;5&#41; s&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;043&#44; all of them achieving the primary endpoint&#46; No differences were found in the change from baseline in ET compared to patients with NAID &#91;238&#46;0 &#40;78&#46;8&#8211;264&#46;5&#41; vs&#46; 103&#46;5 &#40;9&#46;3&#8211;278&#46;0&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;541&#93; or Hb &#91;1&#46;2 &#40;&#8722;0&#46;1&#8211;1&#46;8&#41; vs&#46; 0&#46;5 &#40;&#8722;0&#46;2&#8211;1&#46;2&#41; g&#47;dL&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;383&#93;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Iron status</span><p id="par0075" class="elsevierStylePara elsevierViewall">Analytical parameters before and after treatment or placebo administration were presented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; The administration of intravenous iron resulted in a significant improvement in all the analytical parameters concerned by this ion metabolism &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all comparisons&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Impact of the iron replacement on CAT and DPA</span><p id="par0080" class="elsevierStylePara elsevierViewall">The analysis of these secondary outcomes is summarized in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; There were no statistically significant differences with respect to placebo in the change of the scores of the CAT questionnaire&#46; In patients with mild anaemia treated with intravenous iron&#44; CAT questionnaire improved by &#8722;7&#46;5 &#40;&#8722;16&#46;5&#8211;2&#46;3&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;138&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Post hoc analysis of patients with ferritin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL</span><p id="par0085" class="elsevierStylePara elsevierViewall">The response of patients with ferritin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL to iron therapy was further analyzed and described in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Close to a quarter &#40;22&#46;7&#37;&#41; of patients receiving treatment presented less than 30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL of ferritin&#46; These patients presented a more favourable response&#44; as all of them patients achieved the primary endpoint versus only 38&#46;2&#37; in those with normal ferritin levels &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;77 &#40;95&#37; CI&#44; 1&#46;24&#8211;2&#46;53&#41;&#93;&#46; Overall&#44; these patients improved their endurance time by 101&#46;3&#37; vs&#46; 17&#46;6&#37; in the ferritin<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Furthermore&#44; a trend towards an improvement in the CAT questionnaire was also noticed&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Safety data</span><p id="par0095" class="elsevierStylePara elsevierViewall">No differences were reported between both study groups concerning safety&#46; More specifically&#44; no injection-site pain&#44; discoloration or hypersensitivity reactions were observed after 4 weeks from the treatment&#44; and blood pressure was within normal values throughout the entire course in all patients&#46; Moreover&#44; 6&#46;3&#37; of patients having received treatment presented COPD exacerbation vs&#46; 8&#46;3&#37; in the placebo group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;656&#59; RR&#58; 0&#46;79 &#91;95&#37; CI 0&#46;26&#8211;2&#46;46&#93;&#59; Risk reduction&#58; &#8722;2&#46;33&#37; &#91;95&#37; CI &#8722;15&#46;20&#8211;10&#46;53&#93;&#59; number needed to harm 43 patients&#41; but none of these patients required hospital admission or died&#46; Oral antibiotics were prescribed in two cases and oral corticosteroids were given in the rest&#46; Exacerbation was not considered to be related to the study drug and was defined as grade 2 side effect&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Only one patient did not tolerate the treatment with intravenous iron &#40;2&#46;3&#37;&#44; Risk Reduction&#58; 2&#46;3&#37; &#91;95&#37; CI &#8722;2&#46;13&#8211;6&#46;68&#93;&#59; number needed to harm 46 patients&#41;&#46; This adverse event was considered as grade 1 &#40;mild effect&#59; intervention not indicated&#41; and treatment infusion was continued without further events&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this is the largest study assessing the impact of the intravenous iron supplementation on exercise tolerance in COPD patients with ID with or without mild anaemia&#46; The main finding of this study was that the treatment with intravenous ferric carboxymaltose was associated with a larger improvement in the endurance time compared to placebo&#44; even in patients without mild anaemia&#46; The results of our study confirm our previous hypothesis and fit with those found in other chronic diseases&#46; Based on our predefined subgroup analysis&#44; we also found that patients with a ferritin value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ng&#47;mL performed strikingly better&#46; However&#44; this is only a hypothesis generating data&#46; Finally&#44; iron treatment was well tolerated without significant safety issues&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">ID is estimated to affect two billion people worldwide<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">23</span></a> being the leading cause of anaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">24</span></a> Moreover&#44; ID appears to be responsible for 0&#46;8&#37; of all deaths and 1&#46;3&#37; of all disability-adjusted life years&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">24</span></a> In COPD patients in particular&#44; anaemia and ID are quite common&#46; However&#44; the former is neither sought for or&#44; if found&#44; not treated&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">25</span></a> Furthermore&#44; NAID is observed in almost 40&#8211;50&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">8&#44;26</span></a> The present study shows a NAID prevalence of 40&#37; in a screening of 200 patients&#46; However&#44; although ID and NAID are associated with reduced exercise tolerance and QoL&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">16</span></a> current guidelines of COPD<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">2</span></a> did not recognize these abnormalities as common and clinically relevant comorbidities&#46; In contrast&#44; the 2016 European Society of Cardiology guidelines for the diagnosis and treatment of acute and CHF do recommend ferric carboxymaltose for the treatment of ID to alleviate heart failure symptoms and improve exercise capacity and QoL&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">To date&#44; studies on ID and resultant decreased exercise performance have been performed predominantly in animal models&#44; while data regarding the relationship between ID and skeletal muscle dysfunction in ID anaemic human subjects are limited and inconsistent&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> Furthermore&#44; the benefits of iron replacement have been found in cardiopulmonary diseases other than COPD such as CHF and PAH with ID&#44; with or without anaemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;13&#44;15&#44;29&#8211;32</span></a> In the largest randomized controlled clinical trial including 459 patients with CHF&#44; Anker et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">11</span></a> showed that treatment with intravenous ferric carboxymaltose improved symptomatology&#44; functional capacity and QoL with an acceptable safety profile&#46; Similarly&#44; this treatment can also improve clinical outcomes in PAH patients with ID&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">33</span></a> Moreover&#44; Viethen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">32</span></a> studied the treatment with a single dose of &#8804;1000<span class="elsevierStyleHsp" style=""></span>mg of ferric carboxymaltose in 20 patients with pulmonary hypertension and ID&#44; reporting a significant improvement not only in iron status but in the 6MWT distance and QoL&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">While the effort limitation mechanisms in iron deficiency anaemia may also include oxygen transport&#44; when there is NAID&#44; it might be the result of diminished oxygen utilization in the muscle cells due to impaired synthesis or function of different iron-containing enzymes&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">6</span></a> In fact&#44; experimental data from in vitro and animal studies indicate that skeletal muscle network of pathways for energy production is hampered by ID at different points in the distinct metabolic routes&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> ID affects mitochondrial morphology &#40;such as a decrease in density of cristae in the mitochondrial inner membrane&#41; and dramatically impairs the process of mitochondrial oxidative phosphorylation&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> All these effects may add to the general decrease in oxidative metabolism efficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">9</span></a> This is one of the hypotheses by which NAID may have a negative impact on aerobic capacity<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">16</span></a> and can produce fatigue and exercise intolerance<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">34</span></a> in patients with demonstrated peripheral muscle dysfunction&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">9&#44;35</span></a> On the other hand&#44; it should be mentioned that peripheral muscle strength did not improve following treatment with iron in any of the study groups&#46; These results suggest that factors other than muscle function are major contributors to general exercise tolerance in severe COPD patients&#44; as has been shown in previous reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">36&#8211;39</span></a> As such&#44; it has been demonstrated a mismatch between ventilatory capacity and the patients&#8217; demand&#44; an imbalance between energy requirements and supply to the working respiratory and peripheral muscles&#44; and other factors that contribute to muscle dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">37</span></a> The effects of iron supplementation may go beyond those of skeletal muscle performance&#46; Organs such as the vascular endothelium&#44; myocardium&#44; and the lungs and airways may have also contributed to the improvement in ET seen in the patients who received iron replacement&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">36&#8211;39</span></a> Another interesting possibility is the decrease in myoglobin reserves in the muscle&#44; which would affect its bioenergetics&#46; As Hb&#44; myoglobin is an iron- and -oxygen binding protein&#46; Its function is not completely elucidated but it is believed that it also participates in oxygen storage within the muscle increasing the availability of this gas for aerobic purposes&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">40</span></a> On the other hand&#44; myoglobin as Hb are scavengers of reactive oxygen species&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">41</span></a> This would limit oxidative stress&#44; one of the mechanisms involved in muscle dysfunction repeatedly observed in COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">42</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Considering all this evidence&#44; it is not surprising that in the aforementioned randomized clinical trial conducted in patients with CHF&#44; the treatment with ferric carboxymaltose was beneficial to both patients with anaemia and those without anaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">11</span></a> Our study clearly shows similar results in moderate to severe COPD patients either with mild anaemia or NAID&#46; This suggests that the presence of ID is a valid independent therapeutic target in different chronic diseases&#46; We hypothesize that iron availability in skeletal muscles could have improved their oxidative capacity&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">14</span></a> increasing the time to the anaerobic threshold during submaximal exercise&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">31</span></a> The only previous clinical trial analysing the impact of intravenous iron in COPD was recently published by Santer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">17</span></a> Their primary endpoint &#40;oxygen saturation&#41; was not met although exercise capacity &#40;assessed by the 6MWT&#41; improved&#46; However&#44; this might be explained by the fact that patients&#8217; baseline oxygen saturation was only marginally &#40;&#60;1&#37;&#41; lower than that of age-matched general population&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">17</span></a> The exact mechanisms leading to anaemia and ID in COPD are complex and remain not fully understood&#46; Moreover&#44; iron metabolism in patients with this and other chronic illness merits a more detailed investigation to better unravel the reasons why the correction of ID can result in symptomatic improvements even in the absence of changes in Hb&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Interestingly&#44; we have also observed that the improvement in exercise capacity was especially important in those patients with ferritin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">24&#44;43</span></a> This is probably related to the main functions of this protein&#44; which are iron storage&#44; transportation&#44; and delivery to the tissues&#46; However&#44; our finding deserves further studies to completely understand the mechanisms of such a higher improvement&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our study achieves the primary endpoint showing a 3-fold possibility of a 33&#37; improvement in the endurance time with iron treatment when compared to placebo administration&#46; Although this specific improvement &#40;33&#37;&#41; was defined by the European Respiratory Society task force for nonpharmacological interventions&#44;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">44</span></a> we strongly believe that it should be also valid for pharmacological treatments&#46; On the other hand&#44; the election of the endurance time during CWRET as the primary endpoint was based on the previous use of this variable as the outcome measure in other studies&#44; including those using ferric carboxymaltose&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">19&#44;45</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding the secondary endpoints of the present study&#44; we also observed an improvement in CAT questionnaire in those patients who received ferric carboxymaltose&#46; However&#44; DPA did not change&#46; Our hypothesis for this latter result is that all patients were sedentary&#44; and changes in this dimension normally also involve a behavioural intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">46</span></a></p><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Study critique</span><p id="par0145" class="elsevierStylePara elsevierViewall">Vitamin B12 and folic acid play an important role in the synthesis of haemoglobin and are essential in the homocysteine&#44; mitochondrial&#44; muscle metabolism and haematopoiesis&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">47</span></a> This is a relevant issue as previous results showed that up to 34&#46;4&#37; of COPD patients may exhibit vitamin B12 deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">47</span></a> However&#44; in our cohort&#44; both patients with NAID and mild anaemia presented mean corpuscular volume within normal ranges &#40;&#60;100<span class="elsevierStyleHsp" style=""></span>fl&#41;&#44; thus ruling out the possibility that macrocytic anaemia due to vitamin B12 deficiency may have played any role in the reported findings&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A potential limitation may be related to the lack of maximal inspiratory pressure &#40;PImax&#41; measurements in the study patients&#46; Despite the potential interest of this aspect&#44; the study aimed to assess whether treatment with iron may improve exercise tolerance in COPD patients and eventually DPA&#46; Thus&#44; the focus was rather on peripheral limb muscles than on respiratory muscles&#46; Furthermore&#44; PImax does not necessarily predict the patients&#8217; performance on the cardiopulmonary exercise test&#44; which may limit its usefulness in this setting&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">48</span></a> On the other hand&#44; inspiratory muscle weakness was independently associated with skeletal muscle mass in men with systolic chronic heart failure and ID&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">49</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">It should also be mentioned that mechanisms other than the potential contribution of peripheral muscle dysfunction to exercise tolerance may exist&#46; Alterations in vascular lung homeostasis&#44; namely the reversal of haemodynamic and pulmonary vascular remodelling by iron replacement may have also influenced the results&#44; as also shown to occur in a mouse model of NAID&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">50</span></a> Moreover&#44; intracellular iron deficiency within the pulmonary arterial smooth muscle cells also altered lung vascular function&#44; as demonstrated in another mouse model&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">51</span></a> Despite the relevance of these findings&#44; the current clinical trial was not designed to target these aspects in the cohort of COPD patients&#46; Future studies should be specifically designed to address these relevant questions&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Other limitations should be considered such as the fact that only 4 patients in the subgroup with mild anaemia received carboxymaltose&#46; Although the increase in haemoglobin levels could be involved in the improvement of exercise capacity&#44; the small numbers preclude the analysis of the impact of haemoglobin on the study outcomes&#46; Finally&#44; it should be mentioned that this was a single-blind clinical trial and that the trial was conducted only in one centre&#44; which may question the potential extrapolation of the study results to the general population of COPD patients&#46; However&#44; the current results will contribute to the design of multicentric randomized clinical trials soon&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">The FACE study has shown that intravenous iron carboxymaltose therapy is well tolerated and associated with improvements in exercise tolerance and symptoms in patients with COPD and iron deficiency&#44; with or without anaemia&#46; These benefits were even more evident in patients with low ferritin levels&#46; The assessment of the iron profile and correction of iron status may therefore become part of the follow-up and management of COPD patients&#46; Further studies will answer several unsolved questions such as the potential underlying molecular mechanisms&#44; the long-term benefits of the treatment&#44; and the needs for more infusions&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">This study has been funded by Instituto de Salud Carlos-III &#40;ISCIII&#41;&#44; contract grants FIS 17&#47;00649 and 18&#47;00075 &#91;FEDER&#93;&#41;&#44; BA 17&#47;00025&#46; CIBERES&#44; ESF02&#47;2017&#59; Spanish Respiratory Society &#40;SEPAR&#41; 409&#47;2017&#59; Catalan Foundation of Pulmonology &#40;FUCAP&#41; 2017&#59; and an unrestricted grant from Vifor Pharma 2018&#46; Vifor Pharma did not have any role in the study or statistical analyses&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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              "titulo" => "Improvement of endurance time following iron replacement"
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              "titulo" => "Iron status"
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              "titulo" => "Impact of the iron replacement on CAT and DPA"
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              "titulo" => "Post hoc analysis of patients with ferritin &#60; 30 ng&#47;mL"
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    "fechaRecibido" => "2021-03-11"
    "fechaAceptado" => "2021-08-08"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec1612454"
          "palabras" => array:6 [
            0 => "Non-anaemic iron deficiency"
            1 => "Chronic obstructive pulmonary disease"
            2 => "Exercise limitation"
            3 => "Aerobic capacity"
            4 => "Intravenous iron"
            5 => "Quality of life"
          ]
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        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1612453"
          "palabras" => array:15 [
            0 => "6MWT"
            1 => "CAT"
            2 => "CHF"
            3 => "COPD"
            4 => "CWRET"
            5 => "DPA"
            6 => "ET"
            7 => "FACE"
            8 => "Hb"
            9 => "ID"
            10 => "NAID"
            11 => "PAH"
            12 => "PImax"
            13 => "QMVC"
            14 => "QoL"
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    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Iron deficiency affects exercise capacity because of the critical role iron plays in the optimal functioning of skeletal muscle metabolism&#46; We hypothesized that intravenous iron may improve exercise tolerance&#44; quality of life &#40;QoL&#41;&#44; and daily physical activity &#40;DPA&#41; in patients with chronic obstructive pulmonary disease &#40;COPD&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This was a placebo-controlled&#44; single-blind&#44; parallel-group&#44; randomized clinical trial&#46; Iron deficiency was defined as a ferritin level<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ng&#47;mL or a ferritin level between 100 and 299<span class="elsevierStyleHsp" style=""></span>ng&#47;mL with a transferrin saturation<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20&#37;&#44; with or without mild anaemia&#46; Patients were randomized at a 2&#58;1 ratio to receive intravenous ferric carboxymaltose or placebo&#46; The primary objective was to investigate whether intravenous iron replacement improved endurance time from baseline by at least 33&#37;&#46; The secondary objectives were to evaluate impact on QoL using the COPD Assessment Test &#40;CAT&#41; and on DPA by accelerometry&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We included 66 patients&#44; 44 &#40;66&#46;7&#37;&#41; in the intervention group and 22 &#40;33&#46;3&#37;&#41; in the placebo group&#46; Among patients receiving ferric carboxymaltose&#44; 23 &#40;52&#46;3&#37;&#41; achieved the primary endpoint compared to 4 &#40;18&#46;2&#37;&#41; in the placebo group &#91;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#59; relative risk 3&#46;12&#44; &#40;95&#37; CI&#44; 1&#46;19&#8211;8&#46;12&#41;&#93;&#46; CAT score decreased &#8722;3 &#40;&#8722;6&#46;0&#8211;1&#46;3&#41; points from baseline in the intervention group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#44; in contrast to placebo group &#91;&#8722;1 &#40;&#8722;4&#46;0&#8211;2&#46;3&#41; points&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;236&#93; with no differences in DPA and adverse events in both groups&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Iron replacement improved exercise capacity and QoL in stable COPD patients with iron deficiency&#46; The treatment was well tolerated&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Clinical Trial registration</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">EudraCT 2016-001238-89&#46;</p></span>"
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            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Study flow-chart&#46; PFTs&#58; Pulmonary Functional Tests&#59; ECG&#58; electrocardiography&#59; 6MWT&#58; 6-minute walk test&#59; IET&#58; incremental exercise test&#59; CWRET&#58; constant work-rate exercise test&#59; CAT&#58; COPD Assessment Test&#59; FCM&#58; ferric carboxymaltose&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of FACE &#40;Ferinject Assessment in patients with COPD and iron deficiency to improve Exercise tolerance&#41; study according to CONSORT guidelines&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Data are presented as median &#40;Q1&#8211;Q3&#41; or as absolute number &#40;percentage&#41;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; FFMI&#44; fat free mass index&#59; Glomerular filtration rate was calculated by Chronic Kidney Disease Epidemiology Collaboration&#59; ESR&#44; erythrocyte sedimentation rate&#59; MCV&#44; mean corpuscular &#40;erythrocyte&#41; volume&#59; MCH&#44; mean corpuscular haemoglobin&#59; MCHC&#44; mean corpuscular haemoglobin concentration&#59; FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in 1 s&#59; FVC&#44; forced vital capacity&#59; TLC&#44; total lung capacity&#59; DL<span class="elsevierStyleInf">CO</span>&#44; carbon monoxide diffusion capacity corrected for haemoglobin concentration&#59; PaO<span class="elsevierStyleInf">2</span>&#44; oxygen partial pressure&#59; PaCO<span class="elsevierStyleInf">2</span>&#44; carbon dioxide partial pressure&#59; peak V&#8242;O<span class="elsevierStyleInf">2</span>&#44; peak oxygen uptake&#59; RQ max&#44; maximum respiratory quotient&#59; V&#8242;E max&#44; maximum minute ventilation&#59; HR max&#44; maximum heart rate&#59; V&#8242;O<span class="elsevierStyleInf">2</span>&#47;HR&#44; oxygen pulse&#59; AT&#44; anaerobic threshold&#59; V&#8242;E&#47;V&#8242;CO<span class="elsevierStyleInf">2</span>&#44; ventilatory equivalent for carbon dioxide&#59; LAMA&#44; long-acting antimuscarinic antagonists&#59; LABA&#44; long-acting beta<span class="elsevierStyleInf">2</span>-agonists&#59; ICS&#44; inhaled corticosteroid&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Mediterranean diet&#58; according to the questionnaire performed by Spanish Society of Obesity&#44; available in <span class="elsevierStyleInterRef" id="intr0005" href="https://www.seedo.es/index.php/pacientes/dieta-mediterranea">https&#58;&#47;&#47;www&#46;seedo&#46;es&#47;index&#46;php&#47;pacientes&#47;dieta-mediterranea</span>&#46; Date last updated&#58; December 15&#44; 2020&#46; Date last accessed&#58; December 15&#44; 2020&#46;</p>"
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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">9 &#40;40&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pack-years&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">47&#46;5 &#40;32&#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">45&#46;0 &#40;25&#46;0&#8211;80&#46;0&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mediterranean diet questionnaire</span>&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;5 &#40;6&#46;0&#8211;9&#46;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">9&#46;0 &#40;7&#46;0&#8211;10&#46;0&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Medical history</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&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">20 &#40;45&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;59&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus type II&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">8 &#40;18&#46;2&#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">4 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyslipidaemia&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">19 &#40;43&#46;2&#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">7 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&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;6&#46;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">1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ischaemic cardiomyopathy&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;9&#46;1&#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;9&#46;1&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Charlson comorbidity index</span>&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&#46;0 &#40;3&#46;3&#8211;5&#46;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">4&#46;0 &#40;3&#46;0&#8211;5&#46;0&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory analysis</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinine&#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">0&#46;86 &#40;0&#46;7&#8211;1&#46;04&#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">0&#46;9 &#40;0&#46;7&#8211;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estimated glomerular filtration rate&#44; mL&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&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">82&#46;5 &#40;68&#46;4&#8211;95&#46;0&#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">83&#46;5 &#40;68&#46;3&#8211;90&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total protein&#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">6&#46;9 &#40;6&#46;7&#8211;7&#46;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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;9 &#40;6&#46;6&#8211;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Albumin&#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">4&#46;5 &#40;4&#46;3&#8211;4&#46;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">4&#46;5 &#40;4&#46;2&#8211;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C-reactive protein&#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">0&#46;2 &#40;0&#46;1&#8211;0&#46;3&#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">0&#46;3 &#40;0&#46;1&#8211;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ESR&#44; mm&#47;h&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">8&#46;5 &#40;4&#46;5&#8211;12&#46;0&#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;5 &#40;2&#46;8&#8211;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">386&#46;5 &#40;313&#46;5&#8211;430&#46;3&#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">382&#46;5 &#40;339&#46;5&#8211;480&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vitamin D&#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">11&#46;5 &#40;9&#46;0&#8211;19&#46;0&#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">14&#46;0 &#40;7&#46;8&#8211;28&#46;8&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Iron status</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">14&#46;4 &#40;13&#46;7&#8211;15&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0 &#40;13&#46;9&#8211;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">43&#46;9 &#40;40&#46;9&#8211;46&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;6 &#40;41&#46;2&#8211;47&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">90&#46;7 &#40;88&#46;3&#8211;92&#46;9&#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">90&#46;6 &#40;86&#46;8&#8211;93&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MCH&#44; pg&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">30&#46;2 &#40;29&#46;1&#8211;31&#46;2&#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">30&#46;1 &#40;29&#46;0&#8211;31&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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;1 &#40;32&#46;5&#8211;33&#46;9&#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">33&#46;2 &#40;32&#46;5&#8211;33&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum 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">77&#46;0 &#40;56&#46;7&#8211;109&#46;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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;4 &#40;54&#46;5&#8211;108&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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">56&#46;5 &#40;31&#46;5&#8211;87&#46;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">60&#46;5 &#40;36&#46;8&#8211;93&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Transferrin saturation&#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">20&#46;7 &#40;15&#46;2&#8211;28&#46;1&#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">20&#46;2 &#40;15&#46;4&#8211;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Transferrin&#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">278&#46;0 &#40;245&#46;5&#8211;308&#46;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">264&#46;5 &#40;245&#46;0&#8211;287&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Soluble transferrin receptor&#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">2&#46;9 &#40;2&#46;1&#8211;3&#46;2&#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&#46;0 &#40;2&#46;1&#8211;3&#46;4&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pulmonary function</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; 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">1&#46;3 &#40;1&#46;0&#8211;1&#46;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">1&#46;2 &#40;0&#46;9&#8211;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; &#37; predicted&#46;&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">55&#46;0 &#40;41&#46;0&#8211;60&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;38&#46;5&#8211;54&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FVC&#44; 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">2&#46;7 &#40;2&#46;1&#8211;3&#46;2&#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&#46;9 &#40;2&#46;5&#8211;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FVC&#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">80&#46;5 &#40;71&#46;0&#8211;89&#46;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">83&#46;5 &#40;76&#46;0&#8211;93&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#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">49&#46;4 &#40;41&#46;5&#8211;57&#46;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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;2 &#40;34&#46;5&#8211;50&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TLC&#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">111&#46;5 &#40;100&#46;0&#8211;119&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&#46;0 &#40;100&#46;3&#8211;120&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DL<span class="elsevierStyleInf">CO</span>&#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">53&#46;0 &#40;42&#46;3&#8211;62&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;0 &#40;42&#46;8&#8211;60&#46;3&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Post-bronchodilator</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#44; &#37; predicted&#46;&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">59&#46;0 &#40;46&#46;3&#8211;67&#46;0&#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">49&#46;5 &#40;41&#46;8&#8211;62&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#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">51&#46;5 &#40;41&#46;6&#8211;59&#46;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-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;7 &#40;35&#46;7&#8211;53&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FVC&#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">82&#46;0 &#40;77&#46;0&#8211;94&#46;0&#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">88&#46;5 &#40;79&#46;0&#8211;100&#46;0&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Arterial blood gases</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;6 &#40;69&#46;5&#8211;82&#46;7&#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">81&#46;0 &#40;74&#46;2&#8211;82&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;5 &#40;36&#46;5&#8211;40&#46;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">37&#46;3 &#40;35&#46;1&#8211;41&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SaO<span class="elsevierStyleInf">2</span>&#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">95&#46;0 &#40;93&#46;0&#8211;96&#46;0&#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">95&#46;0 &#40;94&#46;0&#8211;96&#46;5&#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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiopulmonary exercise testing</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peak Load&#44; W&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">68&#46;5 &#40;53&#46;0&#8211;80&#46;0&#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">73&#46;0 &#40;46&#46;8&#8211;87&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peak Load&#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">66&#46;0 &#40;48&#46;0&#8211;91&#46;0&#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">72&#46;0 &#40;54&#46;0&#8211;83&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peak V&#8242;O<span class="elsevierStyleInf">2</span>&#47;kg&#44; ml&#47;min&#47;kg&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;6 &#40;13&#46;0&#8211;19&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;9 &#40;12&#46;6&#8211;17&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peak V&#8242;O<span class="elsevierStyleInf">2</span>&#44; &#37; predicted&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">70&#46;5 &#40;50&#46;5&#8211;93&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;0 &#40;60&#46;5&#8211;81&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RQ max&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">1&#46;1 &#40;1&#46;0&#8211;1&#46;2&#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">1&#46;2 &#40;1&#46;1&#8211;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;E max&#44; l&#47;min&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">40&#46;3 &#40;30&#46;1&#8211;46&#46;9&#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">39&#46;5 &#40;31&#46;6&#8211;52&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;E max&#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">68&#46;0 &#40;54&#46;0&#8211;84&#46;0&#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">69&#46;0 &#40;56&#46;8&#8211;82&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HR max&#44; l&#47;min&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">130&#46;5 &#40;115&#46;3&#8211;140&#46;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">120&#46;1 &#40;111&#46;8&#8211;131&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HR max&#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">82&#46;0 &#40;75&#46;5&#8211;89&#46;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">81&#46;5 &#40;74&#46;0&#8211;84&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;O<span class="elsevierStyleInf">2</span>&#47;HR max&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">8&#46;0 &#40;6&#46;2&#8211;9&#46;2&#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">8&#46;7 &#40;6&#46;5&#8211;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;O<span class="elsevierStyleInf">2</span>&#47;HR max&#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">82&#46;0 &#40;65&#46;5&#8211;89&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;0 &#40;73&#46;0&#8211;102&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oxygen desaturation&#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">0 &#40;0&#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">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;O<span class="elsevierStyleInf">2</span> at AT&#44; ml&#47;min&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">677&#46;5 &#40;548&#46;0&#8211;786&#46;3&#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">551&#46;0 &#40;415&#46;0&#8211;694&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;O<span class="elsevierStyleInf">2</span> at AT&#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">52&#46;0 &#40;45&#46;0&#8211;61&#46;3&#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">44&#46;0 &#40;38&#46;0&#8211;49&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>V&#8242;E&#47;V&#8242;CO<span class="elsevierStyleInf">2</span> at AT&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&#46;0 &#40;32&#46;0&#8211;40&#46;0&#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">37&#46;0 &#40;33&#46;5&#8211;41&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperinsuflation&#44; 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">420&#46;0 &#40;277&#46;5&#8211;562&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">385&#46;0 &#40;0&#46;0&#8211;500&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Final systemic blood pressure&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">190&#46;0 &#40;180&#46;3&#8211;203&#46;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
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LABA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LAMA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ICS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LABA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ICS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LAMA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>LABA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ICS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  """
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                  \t\t\t\t">114&#46;0 &#40;103&#46;0&#8211;127&#46;5&#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">0&#46;017&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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