Soluble urokinase-type plasminogen activator receptor is a novel biomarker predicting acute exacerbation in COPD

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic inflammatory condition, and progresses with acute exacerbations. (AE). During AE, levels of acute phase reactants such as C-reactive protein (CRP) and inflammatory cells in the circulation increase. Soluble urokinase-type plasminogen activator receptor (suPAR) levels increase in acute viral and bacterial infections and in diseases involving chronic inflammation. The purpose of this study was to investigate the effectiveness of suPAR in predicting diagnosis of AE of COPD (AE-COPD) and response to treatment.MethodsThe study population consisted of 43 patients diagnosed with AE-COPD and 30 healthy controls. suPAR, CRP, and fibrinogen levels were measured on the first day of hospitalization and on the seventh day of treatment.ResultsWe found that fibrinogen (P<0.001), CRP (P<0.001), and suPAR (P<0.001) were significantly higher in patients with AE-COPD than in healthy controls. Fibrinogen (P<0.001), CRP (P=0.001), and suPAR (P<0.001) were significantly decreased by the seventh day of treatment. However, the area under receiver operator characteristic curve showed that suPAR is superior to CRP and fibrinogen in distinguishing AE-COPD. There was a correlation between fibrinogen, CRP, and suPAR. However, only fibrinogen was a powerful predictor of suPAR in multiple linear regression. In multiple logistic regression, only suPAR and fibrinogen were strong predictors of AE-COPD (P=0.002 and P=0.014, respectively). Serum suPAR was negatively correlated with forced expiratory volume in 1 second (r=−478, P=0.001).ConclusionsuPAR is a marker of acute inflammation. It is well correlated with such inflammation markers as CRP and fibrinogen. suPAR can be used as a predictor of AE-COPD and in monitoring response to treatment.

C-reactive protein and N-terminal prohormone brain natriuretic peptide as biomarkers in acute exacerbations of COPD leading to hospitalizations

“…Our findings are consistent with previously published smaller studies, which have evaluated CRP either alone or in conjunction with other biomarkers in the diagnosis of AECOPD [11, 27, 38]. A study by Gumus et al examined 43 AECOPD patients admitted to the hospital and reported an AUC of 0.695 using CRP from day 1 and 7 [27]. Another study, by Helmy et al, reported using CRP with IL-6 to diagnose AECOPD patients admitted to ICU, and in predicting 28-day mortality with an AUC of 0.851 [38].…”

Soluble Urokinase-Type Plasminogen Activator Receptor and Arterial Stiffness in Patients with COPD

“…Circulating suPAR levels have been determined in COPD only by a few studies [ 12 – 15 ]. Two studies analysed suPAR during acute exacerbations [ 12 , 13 ].…”

“…So far, only few studies have investigated suPAR in COPD, mainly focusing on acute exacerbations and reporting elevated levels [ 12 , 13 ]. In stable disease, Can et al reported higher serum suPAR levels compared to controls [ 14 ].…”

Vasoactive Intestinal Peptide for Diagnosing Exacerbation in Chronic Obstructive Pulmonary Disease

“…A biomarker with the potential to diagnose AE-COPD would therefore be beneficial for COPD management. Several serum markers have been reported to be upregulated at AE-COPD, such as C-reactive protein [4], copeptin and procalcitonin [35], tumor necrosis factor-α and leptin [36], endothelin-1 [37], fibrinogen [38,39], IL-6 [40], IL-8 [41], eosinophil cationic protein, myeloperoxidase [42] and soluble urokinase-type plasminogen activator receptor [43]. However, there has been no report on the relationship of serum VIP and AE-COPD.…”