engleski

Endothelial dysfunction and systemic inflammation during acute exacerbations of COPD

Objective: Endothelial dysfunction is a possible link between increased cardiovascular mortality and systemic inflammation in patients with COPD. There is a persistent low-grade systemic inflammation in COPD patients, which is upregulated during exacerbations.Endothelial dysfunction, a marker of subclinical atherosclerosis correlates with circulating inflammatory markers in stable COPD. Acute exacerbations of COPD are characterized by a transient aggravation of systemic inflammation and might be accompanied by deteriorated endothelial function.Endothelial dysfunction represents an increased risk for cardiovascular morbidity in COPD patients during acute exacerbations. The aim of this study was to assess the endothelial function and systemic inflammation during acute exacerbation of COPD. Methods: We enrolled patients admitted to hospital due to an acute exacerbation of COPD. We recruited 37 patients (female: n=14) during acute exacerbation. Baseline characteristics were as follows: age 73.2, BMI 26, FEV1 38.5±3.2 % pred. The smoking index was 37 pack-years. Study related procedures comprised measurement of systemic inflammatory markers ( C-reactive protein [CRP] , leukocyte count and fibrinogen ) and endothelial dysfunction markers ( endothelin-1 [ET-1] and von Wilebrand factor [vWF] ).The entire spectrum of measurements was scheduled within two days of hospital admission.The results were compared with those of 35 age-and sex-matched controls without COPD (healthy smokers) with middle age 57.8 years, female n=16, BMI 26. TORAKS 2014 - 4. kongres Hrvatskog torakalnog društva Zagreb, 4 - 7. 6. 2014. Result: The patient and control groups were similar in terms of age, gender and comorbidity. During the acute exacerbations patients showed a median CRP of 24.0 (10.2-95.5), leukocytes of 9.5 (7.2-14.0), fibrinogen 5.1 (4.2-7.7). ET-1 3.47± 1.15 and vWF 238.1 (194.6-293.2) indicating severe endothelial dysfunction. The measurements of systemic inflammatory markers and endothelial dysfunction markers in COPD patient group were significantly higher than in the control group of healthy smokers ( ET 1 p<0, 001, vWF p<0, 001 ; r= -0, 71, CRP p<0, 001, r=-0, 76, fibrinogen p<0, 001, r=-0, 50) Conclusion: Acute COPD exacerbation is associated with significant worsening endothelial function, increasing the risk for cardiovascular morbidity.Furthermore, acute exacerbations deteriorate endothelial function in COPD, probably via aggravation of systemic inflammation.

Endothelial dysfunction; Inflammation; Exacerbation; Lung diseases obstructive

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