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Thromb Haemost 2000; 84(02): 210-215
DOI: 10.1055/s-0037-1613998
Review Article
Schattauer GmbH

Acute Exacerbations of Chronic Obstructive Pulmonary Disease Are Accompanied by Elevations of Plasma Fibrinogen and Serum IL-6 Levels

Jadwiga A. Wedzicha
1   From the Department of Academic Respiratory Medicine, London, UK
,
Terence A. R. Seemungal
1   From the Department of Academic Respiratory Medicine, London, UK
,
Peter K. MacCallum
5   Department of Medical Research Council Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, London, UK
,
Elizabeth A. Paul
4   Department of Statistics, St Bartholomew’s and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London, UK
,
Gavin C. Donaldson
3   Department of Physiology, London, UK
,
Angshu Bhowmik
1   From the Department of Academic Respiratory Medicine, London, UK
,
Donald J. Jeffries
2   Department of Virology, London, UK
,
Thomas W. Meade
5   Department of Medical Research Council Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, London, UK
› Author Affiliations
Funding: The British Lung Foundation
We are grateful for the assistance of Robert Burnell, David Howarth (MRC Epidemiology and Medical Care Unit), Leonette John (Respiratory Function Unit, London Chest Hospital). TARS was funded by The British Lung Foundation.
Further Information

Publication History

Received 07 September 1999

Accepted after resubmission 07 March 2000

Publication Date:
14 December 2017 (online)

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Summary

Background

Respiratory tract infections may acutely increase risk from coronary heart disease (CHD), though the mechanisms have not been defined. Patients with chronic obstructive pulmonary disease (COPD) are prone to repeated exacerbations that are often associated with respiratory infections. These patients also have increased cardiovascular morbidity and mortality. We hypothesized that transient acute increases in plasma fibrinogen, an independent risk factor for CHD, could occur at COPD exacerbation (mediated through a rise in IL6) and thereby provide a mechanism linking respiratory infection to risk of coronary heart disease.

Methods

93 COPD patients [mean (SD) age 66.8 (8.1) years] were followed regularly over one year, with daily diary card monitoring of respiratory symptoms and peak expiratory flow rate (PEFR); 67 patients [mean FEV1 1.06 (0.44) l, FVC 2.43 (0.79) l] were seen during 120 exacerbations. At each visit spirometry was measured and blood samples taken for plasma fibrinogen and Interleukin-6 (IL-6) levels.

Result

At baseline, the mean (SD) plasma fibrinogen was elevated at 3.9 (0.67) g/l in the 67 patients with exacerbations during the study and the median (IQR) IL-6 at 4.3 (2.4 to 6.8) pg/ml. Plasma fibrinogen increased by 0.36 (0.74) g/l at exacerbation (p <0.001), with IL-6 levels rising by 1.10 (−2.73 to 6.95) pg/ml (p = 0.008). There was a relation between the changes in fibrinogen at exacerbation and IL-6 levels (r = 0.348, p <0.001). Multiple regression revealed significantly greater rises in fibrinogen when exacerbations were associated with purulent sputum (b = 0.34 g/l; p = 0.03), increased cough (b = 0.31 g/l, p = 0.019) and symptomatic colds (b = 0.228; p = 0.024).

Conclusions

Plasma fibrinogen levels were elevated in stable patients with COPD and may contribute to the increased cardiovascular morbidity and mortality in these patients. COPD exacerbations increased serum IL-6 levels, leading to a rise in plasma fibrinogen. Thus acute rather than chronic infection may have a role in predisposing to coronary heart disease or stroke.

Keywords

Exacerbations - fibrinogen - IL-6 - COPD - cardiovascular risk
 

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