International Journal of COPD (Mar 2020)

Association Between Routine Blood Biomarkers and Clinical Phenotypes and Exacerbations in Chronic Obstructive Pulmonary Disease

  • Nuñez A,
  • Marras V,
  • Harlander M,
  • Mekov E,
  • Esquinas C,
  • Turel M,
  • Lestan D,
  • Petkov R,
  • Yanev N,
  • Pirina P,
  • Negri S,
  • Miravitlles M,
  • Barrecheguren M

Journal volume & issue
Vol. Volume 15
pp. 681 – 690

Abstract

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Alexa Nuñez,1,2,* Viviana Marras,3,* Matevz Harlander,4 Evgeni Mekov,5 Cristina Esquinas,1 Matjaz Turel,4 David Lestan,4 Rosen Petkov,5 Nikolay Yanev,5 Pietro Pirina,3 Silvia Negri,3 Marc Miravitlles,1,2,6 Miriam Barrecheguren1 1Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain; 2Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Spain; 3Respiratory Unit, AOU Sassari, Sassari, Italy; 4Department of Pulmonary Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; 5Department of Pulmonary Diseases, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria; 6CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain*These authors contributed equally to this workCorrespondence: Marc MiravitllesPneumology Department, Hospital Universitari Vall d´Hebron, P. Vall d’Hebron 119-129, Barcelona 08035, SpainTel +34 934893000Fax +34 93 274 82 08Email [email protected]: 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.Keywords: COPD, blood cells, biomarkers, exacerbation, phenotypes  

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