Combining biomarkers of clot resolution and alveolar basement membrane destruction predicts mortality in the ECLIPSE COPD cohort. (November 2020)

• Record Type: Journal Article
• Authors: Sand, Jannie M.B.; Rønnow, Sarah R.; Langholm, Lasse L.; Karsdal, Morten A.; Manon-Jensen, Tina; Tal-Singer, Ruth; Miller, Bruce E.; Vestbo, Jørgen; Leeming, Diana J.
• Is Part Of: Respiratory medicine. Volume 173(2020)
• Publication Date: 2020-11
• Subjects: COPD -- Biomarkers -- Basement membrane -- Clot resolution -- Fibrinogen -- Mortality; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2020.106185
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is characterized by abnormal epithelial repair resulting in a hypercoagulable state with intra-alveolar accumulation of fibrin and alveolar basement membrane destruction. This study aimed to investigate if the combination of two serological biomarkers evaluating these pathological processes could improve the prediction of mortality risk compared to single biomarkers. Methods: Matrix metalloproteinase-mediated degradation of the type IV collagen α3 chain (C4Ma3), located in the alveolar basement membrane, and plasmin-mediated degradation of crosslinked fibrin (X-FIB), an end-product of fibrinogen, were assessed serologically in a subset of the ECLIPSE cohort (n = 982). Biomarker data were dichotomized into high versus low at the median. Cox regression and Kaplan-Meier curves were used to analyze the predictive value of having one or two high biomarkers for all-cause mortality over two years. Results: COPD participants with high levels of two biomarkers were at significantly higher risk of all-cause mortality with a hazard ratio of 7.66 (95% CI 1.75–33.48; p = 0.007) while participants with one high biomarker were not at significantly higher risk (HR 3.79 [95% CI 0.85–16.94]; p = 0.08). Conclusions: A combination of serological biomarkers of alveolar basement membrane destruction and clot resolution was predictive of all-cause mortality in COPD. The combination of two different pathological aspects may strengthen prognostic accuracy and could be used in conjunction with clinical assessment to guide treatment decisions. Highlights: COPD is characterized by abnormal wound healing and alveolar tissue remodeling. The serological biomarkers X-FIB and C4Ma3 assess two different aspects of pathology. Patients with high levels of both X-FIB and C4Ma3 were at higher risk of mortality. The combination of two pathological aspects of COPD improved prognostic accuracy.