Role of Biomarkers in Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the main actuators of disease-related costs, morbidity, and mortality. Early and adequate recognition of an acute exacerbation as well as an individualized treatment is important to minimize mortality, morbidity, and worsening of lung function. However, the distinction of day-to-day variation of symptoms from exacerbations remains a clinical challenge. Accordingly, the use of laboratory parameters to improve the diagnostic accuracy in AECOPD is an area of continuous interest. In this article, we review the most relevant literature concerning the value of biological circulating blood markers for the diagnosis, assessment of morbidity as well as short-term and long-term survival in patients with COPD exacerbations. Potentially useful biomarkers at exacerbation of COPD might reflect inflammation and infection (C-reactive protein, procalcitonin, interleukin-6, serum interferon-γ–inducible protein), cardiac stress (copeptin, brain natriuretic peptide, atrial natriuretic peptide, pro-adrenomedullin, pro-endothelin), and other pathophysiological mechanisms (leptin and adiponectin, fibrinogen, surfactant protein D). So far, no biomarker has been established to possess the required high sensitivity and specificity for the definite diagnosis of AECOPD. Evidence supports the use of procalcitonin for antibiotic guidance in patients with AECOPD. Re-hospitalization and death within 6 months were particularly common in patients with high copeptin levels at exacerbation. Brain natriuretic peptide identifies patients requiring intensive care. Pro-atrial natriuretic peptide and pro- adrenomedullin levels at exacerbation are associated with a poor long-term survival after exacerbation. Considering the predictive value of serum biomarkers for the assessment of disease severity and outcome, they potentially play a major role in the individualization of therapy in COPD.