Introduction: COPD is a multicomponent disease. There is a need for biological markers for better evaluation of patients . Aim and Objectives:. To test the hypothesis that elevated levels of inflammatory biomarkers fibrinogen, C-reactive protein (CRP) and leukocyte count (WBC) in patients with stable COPD are associated with an increased risk of exacerbation. Patients and methods: 98 COPD patients diagnosed and classified as COPD and 30 age and gender matched healthy subjects with normal pulmonary function were observed. Patient follow-up was performed to evaluate the strength of the associations between biomarker levels and future outcome. Results: Inflammatory biomarkers increase with exacerbation compared to the remission state, mean WBC, CRP and fibrinogen at 12.212 · 109/L, 39.462 mg/L and 5.09 g/L in exacerbation respectively compared to 7.877 · 109/L, 4.142 mg/L and 2.299 g/L in remission with P values Conclusion: Elevated levels of CRP, fibrinogen and leukocyte count in individuals with COPD were associated with increased exacerbation risk. Inflammatory biomarkers as Fibrinogen in particular has emerged as a potentially useful biomarker and requires further investigation.

Role of inflammatory biomarkers in COPD

Background: Mean platelet volume (MPV) and platelet distribution width (PDW) reflects the platelets size and the rate of platelet production in bone marrow and it may used as an indicator of platelet activation and the severity of inflammation. It has been reported that elevated MPV values are associated with stable chronic obstructive lung disease(COPD).The aim of this study, was to assess MPV and PDW values in stable and acute exacerbation period in patients with COPD. Methods: This study included 60 stable COPD patients, 36 COPD patients during exacerbation and 50 healthy controls. The complete blood count parameters retrospectively reviewed. Results: MPV values were 9.56±1.07 and 8.4±0.74 fl during stable period and during exacerbation. MPV values were found significantly lower in acute exacerbation group compared to stable patients and controls. (both p<0.01). Besides the MPV values we also found higher PDW values and white blood cell count in COPD with acute exacerbation (both p<0.01)
. Conclusions: Our results indicate that MPV and PDW values may be used as an acute phase reactant in COPD patients during exacerbation.

Evaluation of mean platelet volume and platelet distribution width in patients with chronic obstructive pulmonary disease

Introduction: The impact of emphysema on the development of acute cor pulmonale (ACP) is poorly understood. Our aim was to evaluate the risk factors for an ACP diagnosis during acute exacerbations of COPD (AECOPD). Methods: We evaluated all consecutive patients hospitalized for AECOPD during a 6-months period in our Department. All patients underwent transthoracic echocardiography (TTE) during acute exacerbation. ACP was defined as RV end-diastolic area (RVEDA)/ LV end-diastolic area (LVEDA) ratio higher than 0.6. A quantitative CT-scan was performed during the first month after the exacerbation. Automatic quantification of less than -950 Hounsfield (LAA%-950) lung attenuation area percentage was performed (Thoracic VCAR software, General Electric, France) and airway remodeling was evaluated. Results: 39 patients (15men ; median age 65 [61-71]years) with severe COPD (median FEV1 34% [27-47%]) were included. TTE was performed within 2 [1-5]days of the admission. ACP incidence was high (79%). The median sPAP was 36.5mmHg [30.5-47.5mmHg] without RV dysfunction (median TAPSE 21.5 [19.1-24.88]mm). The median LAA%-950 was low (7% [1.5-13.2%]) and 97% of patients had bronchial wall thickening. In univariate analysis, age, sex, arterial blood gas and FEV1 were not associated with the presence of ACP. In multivariate analysis, current smoking was associated with the presence of ACP (OR=11.3 [1.3-114.8], p=0.04). Patients with LAA%>12% had less ACP during AECOPD (OR=0.78 [0.64-0.96], p=0.018). Conclusion: We identified an acute cor pulmonale phenotype in AECOPD patients. Current smokers having severe COPD and bronchial remodeling seems to be more at risk than emphysema patients.

Acute cor pulmonale during acute exacerbations of COPD: a new phenotype?

Chronic obstructive pulmonary disease (COPD) is a major global health problem. It is a complex disease characterised by chronic inflammation in the airways by noxious particles. Episodes of increased symptoms called as acute exacerbations are associated with accelerated decline in the lung function. Blood cultures to find out the causative organism in these cases are time consuming. Complete Blood Count (CBC) parameters like Total leukocyte count (TLC), hemoglobin (Hb), platelet count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) are found to be related with COPD and its acute exacerbation. An observational hospital based descriptive study was conducted for a period of six months in the Department of Pathology and Medicine of a tertiary care centre. A total of 144 patients of COPD with acute exacerbation (AECOPD) were included in the study. The mean age of the patients was 70.47 ± 9.49 years with female preponderance (61.1%). Though mean hemoglobin level (13.25 ± 2.70 gm %), (95% CI 12.80-13.69) showed statistical significance, other CBC parameters had no obvious difference among the different groups of AECOPD patients. But we cannot deny on the clinical significance of these parameters. The TLC and platelet count were slightly lower in the AECOPD patients with cor pulmonale when compared with AECOPD patients without cor pulmonale. Similarly, platelet parameters like MPV and PDW were slightly higher in the AECOPD patients who are smokers. Though these parameters were not statistically significant, they are found to be cost effective, time saving and clinically significant which would definitely help in the management of AECOPD patients. Hence, these parameters can be used as an easily measurable AECOPD biomarker.

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S Maharjan

Papers

Role of CBC Parameters in COPD with Acute Exacerbation in a Tertiary Care Center