Combining biomarkers of clot resolution and alveolar basement membrane destruction predicts mortality in the ECLIPSE COPD cohort

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by abnormal epithelial repair resulting in a hypercoagulable state with intra-alveolar accumulation of fibrin and alveolar basement membrane destruction. This study aimed to investigate if the combination of two serological biomarkers evaluating these pathological processes could improve the prediction of mortality risk compared to single biomarkers. Methods: Matrix metalloproteinase-mediated degradation of the type IV collagen α3 chain (C4Ma3), located in the alveolar basement membrane, and plasmin-mediated degradation of crosslinked fibrin (X-FIB), an endproduct of fibrinogen, were assessed serologically in a subset of the ECLIPSE cohort (n = 982). Biomarker data were dichotomized into high versus low at the median. Cox regression and Kaplan-Meier curves were used to analyze the predictive value of having one or two high biomarkers for all-cause mortality over two years. Results: COPD participants with high levels of two biomarkers were at significantly higher risk of all-cause mortality with a hazard ratio of 7.66 (95% CI 1.75-33.48; p = 0.007) while participants with one high biomarker were not at significantly higher risk (HR 3.79 [95% CI 0.85-16.94]; p = 0.08). Conclusions: A combination of serological biomarkers of alveolar basement membrane destruction and clot resolution was predictive of all-cause mortality in COPD. The combination of two different pathological aspects may strengthen prognostic accuracy and could be used in conjunction with clinical assessment to guide treatment decisions.

Chronic obstructive pulmonary disease risk assessment tools: is one better than the others?

“…Low concentrations of interleukin-15, a pleiotropic cytokine that induces proliferation of natural killer cells, and high concentrations of interleukin-8, a cytokine targeting neutrophils, have been associated with an increased risk of exacerbations [8]. High levels of endotrophin and von Willebrand factor as well as other markers of epithelial repair, alveolar destruction, and endothelial dysfunction have been correlated with higher morbidity and mortality in COPD [53 ▪ –56 ▪ ]. Low-serum IgG and free light chain levels have been linked to a higher risk of exacerbation and hospitalization, which suggests a potential role for intravenous immunoglobulin administration in COPD patients with recurrent exacerbations [57 ▪ –59 ▪ ].…”