Fibrinogen, a Promising Marker to Evaluate Severity and Prognosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study

Abstract

Background Fibrinogen is increasingly being studied as an inflammatory biomarker in chronic obstructive pulmonary disease (COPD), but there are limited data on the role of fibrinogen in assessing the severity of acute exacerbation of COPD (AECOPD). This study aimed to explore whether circulating fibrinogen could be used as a surrogate to measure the severity and predict the prognosis of AECOPD. Methods A total of 535 AECOPD patients diagnosed at our center from January 2016 to June 2021 were retrospectively enrolled in this study. The electronic medical record of each patient was retrieved to collect data on baseline characteristics and laboratory parameters, as well as the use of noninvasive positive-pressure ventilation (NPPV) and prognosis. Multiple linear regression analysis was used to identify independent factors associated with circulating fibrinogen values. Receiver-operating characteristic curve and multivariate logistic regression analysis were applied to further verify the use of fibrinogen to predict NPPV failure. Results Compared to patients with fibrinogen <4 g/L, patients with increased fibrinogen levels (>4 g/L) tended to have elevated inflammatory response and higher incidence of DVT/PTE, emphysema, pneumonia, and atherosclerosis. In addition, fibrinogen levels in NPPV-failure patients were significantly higher than non-NPPV patients and NPPV-success ones. The presence of emphysema, pneumonia, and history of long-term oxygen therapy and higher CRP levels and leukocyte counts were independent risk factors associated with increased fibrinogen levels in AECOPD. Furthermore, our data indicated that fibrinogen could be considered as a reliable biomarker to predict NPPV failure (AUC, 0.899, 95% CI 0.846–0.952), with an OR of 7.702 (95% CI 2.984–19.875; P <0.001). Conclusion The level of circulating fibrinogen can be used to measure severity of AECOPD, and among AECOPD patients managed with NPPV, fibrinogen >3.55 g/L can independently predict NPPV failure.

Local Production of Acute Phase Proteins: A Defense Reaction of Cancer Cells to Injury with Focus on Fibrinogen

“…Elevated fibrinogen levels are linked to inflammation, exacerbations, severity, and mortality in chronic obstructive pulmonary disease [ 43 ].…”

Analyses of Factors Associated with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Review

“…In patients with COPD, the occurrence of airflow limitation, thromboembolism, emphysema, and atherosclerosis are more prevalent when FIB levels exceed 4g/L. 128 , 129 Several studies have demonstrated a negative correlation between FIB level and FEV1, as well as a positive correlation with AE rate, readmission rate, exercise tolerance, and COPD mortality. This suggests that FIB level can serve as a biomarker for predicting the failure of NIV in COPD patients.…”

Correlation of Serum Clara Cell Secretory Protein 16, Plasma Fibrinogen and Serum Amyloid A with the Severity of Acute Exacerbated COPD and Their Combination in Prognosis Assessment

“…In addition, fibrinogen (FIB) is another promising serum biomarker for AECOPD as suggested in a previous study. 12 FIB is a glycoprotein synthesized by hepatocytes and its biological functions are closely related to blood coagulation, cell adhesion, proliferation and extension, phagocytosis and other activities. 13 Its molecular weight is the largest among all coagulogens, and it has a chain-like asymmetric structure, which can increase plasma thickening, contribute to the formation of tiny arterial thrombi in the lungs, and aggravate the injury to the lung.…”