Beyond Standard Biomarkers: Investigating the Role of Hemostatic Biomarkers in Predicting Outcomes of Acute Exacerbation of Chronic Obstructive Pulmonary Disease. A Prospective Cohort Study

Abstract

Background: To evaluate the prognostic role of admission hemostatic biomarkers—mean platelet volume (MPV), D-dimer, and fibrinogen—in patients with chronic obstructive pulmonary disease (COPD), with particular emphasis on adverse outcomes and in-hospital mortality during acute exacerbations of COPD (AECOPD).

Methods: This was a Prospective cohort study conducted in Pak Emirates Military Hospital (PEMH), Rawalpindi, Pakistan, from August 11, 2024, to January 11, 2025. A total of 300 adults aged 40–65 years with spirometry-confirmed COPD (post-bronchodilator FEV₁/FVC <0.70) were enrolled, including 159 patients classified as stable COPD and 141 presenting with AECOPD. Demographic and clinical characteristics, spirometric indices, fibrinogen, D-dimer, and MPV were recorded. Fibrinogen was assessed by the Clauss method, D-dimer by a high-sensitivity immunoturbidimetric assay, and MPV from the admission complete blood count. Outcomes included in-hospital mortality, intensive care unit (ICU) admission, length of hospital stay, and clinical deterioration requiring oxygen or ventilatory support. Independent-samples t tests, chi-square testing, effect-size estimation, and receiver operating characteristic (ROC) curve analysis were performed using IBM SPSS Statistics version 25.

Results: Of 300 patients, 240 (80.0%) were male and 60 (20.0%) were female; 22 patients died during hospitalization. AECOPD patients had higher fibrinogen (568 ± 112 vs 378 ± 68 mg/dL) and D-dimer concentrations (1,650 ± 850 vs 450 ± 180 μg/L) than stable COPD patients, while mean MPV in AECOPD was 10.8 ± 1.4 fL. Compared with survivors, patients who died had lower FEV₁ (38.2 ± 12.1% vs 53.1 ± 16.4%) and higher MPV (11.6 ± 1.5 vs 9.8 ± 1.3 fL), D-dimer (2,520 ± 1,245 vs 1,148 ± 852 μg/L), and fibrinogen (710 ± 148 vs 468 ± 112 mg/dL). ROC analysis demonstrated good discriminatory performance for reverse-coded FEV₁ (AUC 0.920), fibrinogen (AUC 0.830), MPV (AUC 0.823), and D-dimer (AUC 0.765) for in-hospital mortality. ICU admission was also associated with mortality in the reported analysis (χ² = 5.42, p = 0.022).

Conclusion: Admission fibrinogen, D-dimer, and MPV showed clinically relevant associations with adverse outcomes in COPD, and ROC analysis indicated potential value for mortality risk stratification. These inexpensive, readily available markers may complement spirometric and clinical assessment in hospitalized patients, although validation in larger multicenter cohorts and adjusted prognostic models is required.