Utility of serum Aspergillus-galactomannan antigen to evaluate the risk of severe acute exacerbation in chronic obstructive pulmonary disease.

Katsuhiro Yoshimura,Yusuke Inoue,Naoki Inui,Hironao Hozumi,Tomoyuki Fujisawa,Yutaro Nakamura,Koji Nishimoto,Kazutaka Mori,Yuzo Suzuki,Shiro Imokawa,Kazuki Furuhashi,Noriyuki Enomoto,Masato Karayama,Takafumi Suda,Koushi Yokomura

doi:10.1371/journal.pone.0198479

Abstract

BackgroundRecent studies have shown that the microbiome, namely Aspergillus species, play a previously unrecognized role in both stable and exacerbated chronic obstructive pulmonary disease (COPD). Galactomannan is a major component of the Aspergillus cell wall that has been widely used as a diagnostic marker.ObjectivesTo explore whether serum levels of Aspergillus-galactomannan antigen could be used to evaluate the risk of severe acute exacerbation of COPD (AE-COPD).MethodsWe measured the Aspergillus-galactomannan antigen levels of 191 patients with stable COPD, and examined its clinical relevance including AE-COPD.ResultsThere were 77 (40.3%) patients who were positive for serum Aspergillus-galactomannan antigen (≥0.5). High Aspergillus-galactomannan antigen level (≥0.7) was associated with older age and presence of bronchiectasis and cysts on computed tomography images. Compared to patients with low Aspergillus-galactomannan antigen level (<0.7), patients with high Aspergillus-galactomannan antigen level had significantly higher incidence of severe AE-COPD (P = 0.0039, Gray’s test) and respiratory-related mortality (P = 0.0176, log-rank test). Multivariate analysis showed that high Aspergillus-galactomannan antigen level was independently associated with severe AE-COPD (hazard ratio, 2.162; 95% confidence interval, 1.267−3.692; P = 0.005).ConclusionSerum Aspergillus-galactomannan antigen was detected in patients with COPD, and elevated serum Aspergillus-galactomannan antigen was associated with severe AE-COPD.

Highlights

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease
Multivariate analysis showed that high Aspergillus-galactomannan antigen level was independently associated with severe acute exacerbation (AE)-chronic obstructive pulmonary disease (COPD)
Serum Aspergillus-galactomannan antigen was detected in patients with COPD, and elevated serum Aspergillus-galactomannan antigen was associated with severe Acute exacerbation of COPD (AE-COPD)

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. COPD imposes a significant burden on patients and is the fourth leading cause of death in the world [1]. AE-COPD can cause an accelerated decline of pulmonary function, leading to death [1,2,3]. To prevent and determine the risk of future exacerbation episodes, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) developed the ABCD assessment tool beyond the simple spirometric grading system [1]. Current GOLD guidelines recommend treatment strategies based on ABCD-estimated risk of AE-COPD. Recent studies have shown that the microbiome, namely Aspergillus species, play a previously unrecognized role in both stable and exacerbated chronic obstructive pulmonary disease (COPD). Galactomannan is a major component of the Aspergillus cell wall that has been widely used as a diagnostic marker

Objectives

Methods

Results

Conclusion