<p>Association Between Routine Blood Biomarkers and Clinical Phenotypes and Exacerbations in Chronic Obstructive Pulmonary Disease</p>

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with increased lung and systemic inflammation. We aimed to identify associations between easy-to-obtain blood biomarkers and the frequency and severity of exacerbations. Methods: Cross-sectional, multicentre study performed in four centres in Spain, Italy, Bulgaria, and Slovenia. Blood samples were obtained for blood cell count, C-reactive protein (CRP), alpha-1 antitrypsin (AAT) and fibrinogen analysis. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and eosinophil/basophil ratio (EBR) were calculated. Firstly, patients were divided into clinical phenotypes according to the Spanish guidelines of COPD, and secondly, patients were classified into 2 groups: non-exacerbators (≤1 ambulatory exacerbation in the previous year) and exacerbators (≥2 ambulatory exacerbations or 1 hospitalisation in the previous year). A multivariate stepwise logistic regression model was performed to identify laboratory parameters associated with exacerbators. Results: A total of 355 patients with a mean age 66 years (SD=8.9) were included, and 64% were male. The mean FEV1% (forced expiratory volume in the first second) was 55% (SD=20%), and the mean COPD Assessment Test (CAT) score was 15.6 (SD=7.9). One hundred ninety-six (55.2%) patients were classified in the non-exacerbator group, and 159 (44.8%) were exacerbators. Patients in the exacerbators group presented lower haemoglobin levels (p=0.019) and ERB (p= 0.023) but higher CRP levels (p=0.001). In the multivariate analysis, females, higher levels of CRP, lower FEV1% and low EBR were independently related to exacerbators. Conclusion: Female sex, having a more severe impairment of lung function, higher CRP levels and a lower EBR are associated with an exacerbator phenotype in COPD.

<p>Systemic Cytokine Profiles of CD4+ T Lymphocytes Correlate with Clinical Features and Functional Status in Stable COPD</p>

“…15,16 However, the findings on systemic inflammation biomarkers and clinical characteristics of COPD are contradictory. [15][16][17][18][19][20][21] In this way, it is essential to investigate the cell line responsible for synthesizing cytokines that orchestrate inflammation in stable COPD. 22 In addition, exploring correlations not previously investigated between the intracellular inflammatory profile and clinical characteristics and functional status, may contribute to the management of this heterogeneous group of patients, with more promising results and better outcomes.…”

Relationship of Red Cell Index&nbsp;with the Severity of&nbsp;COPD

“…At the same time, PLR was signi cantly associated with an increase in 90day mortality. In addition, there is no difference between NLR, PLR and COPD A-D groups [8]. Relevant studies have shown that the lung is related to the production of platelets [9].…”

“…The PLR of patients with stable COPD is signi cantly higher than that of healthy controls, while the PLR level of non-survivors with acute exacerbation of COPD is signi cantly higher, but compared with NLR, PLR is still more effective and simple prognostic indicators [36]. The cross-sectional multi-center study of Alexa et al [8] showed that NLR and PLR are predictors of COPD, but there is no correlation between the two and FEV1, and there is no correlation between the two groups and the GOLD A-D group.…”

Potential Use of Alpha-1 Anti-trypsin in the Covid-19 Treatment

“…More than 100 allelic variants of the gene coding for the AAT, called Serine Protease Inhibitor-A1 (SERPINA1) exist, whereas many of them are associated with reduced circulating protein levels or altered protein activity (Bornhorst et al, 2007). Individuals with AAT deficiency (AATD), in the presence or in the absence of concomitant factors such as smoke, environmental pollutants, and age, have a very high risk of developing pathologies of the respiratory system, such as pulmonary emphysema and chronic obstructive pulmonary disease (COPD) associated to a progressive damage of lung parenchyma (Nuñez et al, 2020).…”

“…Patients affected by COPD frequently present exacerbations, often triggered by bacterial/viral respiratory infections or viruses, which lead to disease progression through an exaggerated inflammatory response, therefore requiring pharmacological treatments (Xiong et al, 2017). COPD exacerbations are characterized by high neutrophil counts, and high levels of C-reactive protein (CRP), as well as inflammatory cytokines including tumor necrosis factor α (TNFα), interleukin-1 (IL1), interleukin-8 (IL8) and IL6 (Bradford et al, 2017;Xiong et al, 2017;Nuñez et al, 2020).…”