Rationale: Two adipokines, leptin and adiponectin, regulate metabolic and inflammatory systems reciprocally. The role of adiponectin in chronic obstructive pulmonary disease (COPD) has been studied. However, there are few data evaluating the relationship of plasma leptin with COPD severity or progression. Objectives: The objective of this study was to evaluate the relationship of leptin, adiponectin, and the leptin/adiponectin ratio with COPD severity and progression according to COPD phenotypes. Methods: Plasma leptin and adiponectin levels were measured in 196 subjects with COPD selected from the Korean Obstructive Lung Disease cohort. Using a linear regression model and mixed linear regression, we determined the relationship of plasma leptin and adiponectin levels and the leptin/adiponectin ratio to COPD severity and progression over 3 years. Measurements and Main Results: The concentration of adiponectin in plasma positively correlated with percent emphysema on initial computed tomography (CT) (adjusted P = 0.022), whereas plasma leptin concentrations and the leptin/adiponectin ratio exhibited a significant inverse correlation with initial FEV1 (adjusted P = 0.013 for leptin and adjusted P = 0.041 for leptin/adiponectin ratio). Increased plasma leptin and leptin/adiponectin ratio were significantly associated with change in percent emphysema over 3 years (adjusted P = 0.037 for leptin and adjusted P = 0.029 for leptin/adiponectin ratio), whereas none of the adipokines demonstrated an association with FEV1 decline over the 3-year period. Conclusions: Plasma adiponectin and leptin vary according to COPD phenotypes. Plasma leptin and the leptin/adiponectin ratio, but not adiponectin, were significantly associated with changes in CT-assessed emphysema, suggesting a potential role as a biomarker in emphysema progression in patients with COPD.

Background: Surgical resection is the cornerstone treatment for pulmonary mucormycosis, a lethal fungal infection. It is unclear why some patients do not receive surgery, and the natural courses of these patients have not been well evaluated. Methods: A retrospective review was performed using the medical records of 20 patients with pathologically-confirmed pulmonary mucormycosis. We evaluated the reasons for not receiving surgery and compared treatment outcomes between patients who did and did not undergo surgery. Results: Overall survival rate was 50%. Nine of 11 (82%) patients who underwent surgery survived; however, only 1 of 9 (11%) patients who did not undergo surgery survived. Reasons for not receiving surgery were death shortly after diagnosis (n=1), altered mental state (n=1), refractory underlying disease (n=3), and refusal by patient due to concern of operative risk (n=4). Patients who did not undergo surgery were more likely to be older (P=0.018), have a longer duration of steroid use (P=0.021), higher lactate dehydrogenase level (P=0.039), higher sequential organ failure assessment (SOFA) score (P=0.035), and higher rate of cytomegalovirus (CMV) infection (P=0.020) than those did receive surgery. Surgery was the only favorable survival factor in multivariable analyses (adjusted odds ratio for survival =15.45; P=0.029). Conclusions: The main reasons for not undergoing surgery in patients with pulmonary mucormycosis were the gravity of underlying diseases and concerns for operative risk. Although overall survival rate was poor, it was significantly higher in patients who received pulmonary resection surgery. The decision to undergo lung resection is time-sensitive and essential in improving survival rate in patients suffering from pulmonary mucormycosis, despite perioperative risks.