Prospective Biomarkers in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease

<bold>Background:</bold> In the age of personalized medicine, the call for novel biomarkers is immense. Here we investigate three possible prognostic biomarkers in patients with chronic obstructive pulmonary disease (COPD): Growth differentiation factor-15 (GDF-15) and surfactant protein D (SPD) both being released during inflammation with the latter being highly sensitive for lung tissue, and thrombomodulin (TM) that is released during vascular stress and inflammation. <bold>Aim:</bold> To determine whether specific biomarkers can predict decline in lung function following hospitalization for exacerbation of COPD (ECOPD). <bold>Methods:</bold> Details on the study population up have been published earlier (Sivapalan et al., 2019). Change in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) between baseline and follow-up visits is evaluated using a linear mixed model with time as a categorial variable and biomarkers as a dichotomized covariate (75th percentile). The adjusted model further included age, sex, weight, height, smoking status, previous ECOPD, pH, pCO2. To account for the correlation in the repeated measurements as well as possible variance over time, we assumed an unstructured covariance pattern. <bold>Results:</bold> High levels of SPD were associated with a decline in ΔFEV₁ 30 days: -79 mL (95%CI: -172;16, p=0,11) and 90 days -123 mL (95%CI: -222; -24, p=0,02) but not with ΔFVC. No difference in neither ΔFEV₁ nor ΔFVC were found for GDF-15 and TM. <bold>Conclusion:</bold> We propose that SPD may be a prognostic marker in COPD during severe exacerbations, thus helping identifying patients with a slow recovery of lung function following an exacerbation. However, our findings will have to be verified in a larger cohort.