Effect of Corticosteroids on Hemostasis and Pulmonary Arterial Pressure during Chronic Obstructive Pulmonary Disease Exacerbation

Abstract

Background: Hemodynamic and hemostatic abnormalities are reportedly frequent in chronic obstructive pulmonary disease (COPD). Objectives: We investigated the changes in systolic pulmonary artery pressure (PAPs) and hemostatic status and the effects of systemic steroid treatment (SST) during COPD exacerbation. Methods: Consecutive 26 male and 4 female patients as well as 10 controls were enrolled. The nonsteroid treatment (NST) group received standard treatment without steroids, and the other group received additional SST. Initial values of blood gases, spirometry and PAPs, P-selectin, D-dimer and fibrinogen levels, activities of thrombocyte aggregation, antithrombin III (AT III), protein C (PC), protein S, activated PC resistance (APCR), prothrombin time and partial thromboplastin time were obtained and compared with values at day 10. Results: Improvement in spirometry and blood gases was more prominent with SST. At presentation, patients had higher PAPs, P-selectin, D-dimer and fibrinogen but lower AT III levels than controls. PAPs and fibrinogen levels significantly decreased in the SST group while P-selectin levels further increased in the NST group. The D-dimer level significantly decreased in both groups. Means of AT III, PC and protein S increased in the SST and decreased in the NST group, but only the decrease in PC in the NST group was meaningful. Compared with the controls, AT III levels in the NST group and activated PC resistance in the SST group were significantly decreased. Thrombocyte aggregation tests suggested an incline after 10 days in both groups. Conclusions: We suggest that in patients with COPD exacerbation, addition of systemic corticosteroids to treatment results in better outcome in normalization of PAPs, hemostasis, pulmonary functions and blood gases.

Searching for biomarkers of chronic obstructive pulmonary disease using proteomics: The current state

“…The increase in these subjects of the so‐called fragment D forming the D‐dimer, a degradation product of fibrinogen which is used as an indicator for significant clot formation and breakdown, was also underlined. The same finding had been previously reported by other authors in patients with COPD exacerbation .…”

Systemic corticosteroid forCOPDexacerbations, whether the higher dose is better? A meta‐analysis of randomized controlled trials

“…The result did not significantly change when we excluded the low‐quality study . The overall ▵FEV1 changed from 0.107 (95% CI: 0.078–0.135) to 0.109 (95% CI: 0.081–0.138) after excluding that study.…”

“…Our initial database search retrieved 1400 citations. Overall, 22 papers related to SCS and AECOPD were selected from these citations , and 8 were selected from bibliographies of the systematic reviews or meta‐analyses . Finally, 12 studies involving 1172 patients were included in this study.…”

Blood fibrinogen as a biomarker of chronic obstructive pulmonary disease: Table 1

“…Many cross-sectional studies have shown that blood fibrinogen levels are higher in individuals with COPD compared with healthy controls 16–18 33 36 50. A meta-analysis confirmed this finding and noted that it is independent of current smoking status 19.…”