Unraveling the Complexities of Coagulation Dysfunction in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Investigating the Interplay between Infection, Hypercapnia and Hemostatic Abnormalities

Abstract

Objective: To understand how the acute exacerbations of chronic obstructive pulmonary disease (COPD) can lead to coagulation dysfunctions causing hemostatic abnormalities (prolonged prothrombin time, slightly longer activated partial thromboplastin time, higher fibrinogen levels, higher D-dimer levels, and slightly lower platelet counts). Study Design: Comparative cross-sectional. Place and Duration of Study: The study was conducted at the Department of Internal Medicine Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan during the period of July 2023 to December 2023. Methods: The current study utilized patients with a confirmed diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) who were hospitalized in the respiratory care unit and were above 50 years of age. A total of 200 patients were accessed including their demographic characteristics (age, gender, residence, and job), clinical parameters (spirometry results (Forced expiratory volume in one second/Functional vital capacity ratio), complete blood counts, fibrinogen, prothrombin, activated partial thromboplastin time, D-dimers and arterial blood gas analysis. The intricate relationship between coagulation dysfunction and acute exacerbations of chronic obstructive pulmonary disease was analyzed using SPSS 26. Results: The results obtained that; patients with acute exacerbation of chronic obstructive pulmonary disease had prolonged prothrombin time (13.5 ± 1.2 seconds, P < 0.001) slightly longer aPTT (32.1 ± 2.5 seconds, P = 0.014), along with higher fibrinogen levels (350.2 ± 45.8 mg/dL, P < 0.001) and D-dimer levels (550.4 ± 120.3 ng/mL, P = 0.002), as compared to patients with stable chronic obstructive pulmonary disease. The platelet counts of Acute exacerbation of chronic obstructive pulmonary disease patients obtained were slightly lower (260.3 ± 45.4x10^3/μL, P = 0.009) compared to stable chronic obstructive pulmonary disease patients. Furthermore, results provided that coagulation dysfunction was significantly associated with infection, hypercapnia, and acute exacerbation of chronic obstructive pulmonary disease. The prevalence of coagulation dysfunction markers was higher among patients with acute exacerbation of chronic obstructive pulmonary disease. Conclusion: Coagulation dysfunction and its associated risk factors are higher in patients with acute exacerbation of chronic obstructive pulmonary disease and are elevated with increased exposure to air pollution.

Keywords

• chronic obstructive pulmonary disease (copd), exacerbation, fibrinogen, hemostatic, hypercapnia, infection