Prognostic biomarkers for cardiovascular risk in patients with acute exacerbation of Chronic Obstructive Pulmonary Disease: A sub study of the RCT CORTICO-COP.

<bold>Background:</bold> Exacerbating chronic obstructive pulmonary disease (AECOPD) patients are at increased risk of cardiovascular events and mortality. Growth differentiation factor-15 (GDF-15) and Syndecan-1, markers of endothelial dysfunction, have been suggested as prognostic biomarkers. We assessed their association with major adverse cardiovascular events (MACE) or mortality over 5 years. <bold>Methods:</bold> This sub-study of the CORTICO-COP RCT included 299 AECOPD patients. Baseline concentrations of GDF-15 and Syndecan-1 were measured. Secondary outcomes included mortality, heart failure and future-AECOPD. Hazard ratios (HRs) were adjusted for age, smoking, sex, GOLD-class, and kidney insufficiency. <bold>Results:</bold> Higher GDF-15 were associated with an increased risk of MACE or mortality (HR 1.60, 95%confidence interval [CI] 1.10-2.34, p=0.014), mortality (HR 1.50, 95%CI 1.04-2.15,p=0.028), and a lower risk of future AECOPD (HR 0.63, 95%CI 0.42-0.93, p=0.025). No association was found with heart failure (p=0.088). GDF-15 showed moderate predictive ability for survival (AUC 65.9% at 6 months). Higher Syndecan-1 showed no association with MACE or mortality (p=0.73), mortality(p=0.21), heart failure (p=0.26), or future AECOPD (p=0.59). <bold>Conclusion:</bold> GDF-15 is a promising biomarker in plasma for identifying high-risk AECOPD patients, whereas Syndecan-1 was of no prognostic value. <fig><object-id>erj;66/suppl_69/PA5293/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>