Biomarkers of prothrombotic state and risk assessment of exacerbations in patients with Chronic Obstructive Pulmonary Disease

Background Epidemiologic studies have shown that exacerbation of COPD suffered from the morbidity and mortality from venous thromboembolism (VTE) and poor diagnosis. Von Willebrand factor (vWF) and plasminogen activator inhibitor type-1 (PAI-1) are frequently investigated in COPD as the crucial parameter for coagulation and fibrinolysis. Nevertheless, the role of vWF and PAI-1 in ECOPD needs further exploration. Objective We sought to evaluate the hypercoagulability in ECOPD and investigate the association of plasma vWF and PAI-1 with the symptoms and risk of exacerbation of COPD. Methods 57 ECOPD patients and 34 control subjects were enrolled in our study. The concentration of plasma vWF and PAI-1 were measured by ELISA kit. Independent samples t-test or Wilcoxon rank sum test were applied for group comparison. Spearman correlation analysis, subject work curve (ROC) analysis, and Logistic regression were used to evaluate the plasma vWF and PAI-1 in ECOPD. Results Plasma vWF and PAI-1 correlated in total participants and ECOPD subgroups. Compared with control subjects, vWF and PAI-1 in COPD patients are higher. Both vWF and PAI-1 have a high value in predicting the risk of COPD (vWF: AUC = 0.8741, P < 0.001; PAI-1: AUC = 0.8222, P < 0.001). Moreover, elevated vWF could be an independent risk factor for COPD (OR = 1.01, 95%CI:1.00-1.01, P = 0.01). Compared to the COPD “AB” group, the plasma concentrations of vWF and PAI-1 significantly increased in the "E" group. The better predictive effects of vWF and PAI-1 on the exacerbation risk of COPD presented. Plasma vWF positively correlated with patients' CAT scores and SGRQ scores. Conclusion The increased risk for COPD occurrence and exacerbation would be reflected in the high level of plasma vWF, and PAI-1 could be a complementary biomarker.