TY - JOUR

T1 - Fibrin degradation products and survival in patients with chronic obstructive pulmonary disease

T2 - a protocolized prospective observational study

AU - Kamstrup, Peter

AU - Sivapalan, Pradeesh

AU - Rønn, Christian

AU - Rastoder, Ema

AU - Modin, Daniel

AU - Kristensen, Anna Kjaer

AU - Bendstrup, Elisabeth

AU - Sørensen, Rikke

AU - Biering-Sørensen, Tor

AU - Ulrik, Charlotte Suppli

AU - Vestbo, Jørgen

AU - Jensen, Jens Ulrik

N1 - Publisher Copyright: © 2023, The Author(s).

PY - 2023

Y1 - 2023

N2 - Background: Patients with chronic obstructive pulmonary disease (COPD) have a high incidence of cardiovascular disease including thromboembolisms. Fibrin degradation products, like D-dimer, have been associated with death from all causes in healthy individuals and COPD patients. We aimed to determine the (i) association between D-dimer levels and all-cause mortality and time being alive and out of a hospital, (ii) possible modifying effect of anticoagulant treatment, and (iii) distribution of D-dimer in patients with moderate to severe COPD. Methods: Results of routinely measured stable phase D-dimer samples from COPD-outpatients at Copenhagen University Hospital – Herlev and Gentofte, COPD-outpatient clinic were collected using the Danish registries. These were used to examine whether COPD-patients with a D-dimer level in the upper quartile, had a higher risk of death from all causes within 365 days. Results: In the unadjusted Cox proportional hazards regression we found an association between high D-dimer and all-cause mortality: Hazard ratio (HR): 2.3 (95% Confidence Interval (CI) 1.1–4.7). In the fully adjusted regression, the HR was 1.8 (CI 0.8–3.9). We did not find any interaction between D-dimer and anticoagulant or antiplatelet therapy. For the secondary outcome, proportion of days alive and out of hospital in 365 days (pDAOH), the unadjusted multiple linear regression had an association between high D-dimer level and pDAOH: -2.7% points (pp) (CI -3.9 pp - -1.5 pp), which was attenuated to -1,7pp (-2.9pp – -0.4pp) in the fully adjusted regression. Conclusions: In patients with moderate to severe COPD, patients with a high level of D-dimer were more likely to die; however, the signal was not strong in the adjusted analyses and our results do not support unselected risk stratification with D-dimer in COPD-outpatients.

AB - Background: Patients with chronic obstructive pulmonary disease (COPD) have a high incidence of cardiovascular disease including thromboembolisms. Fibrin degradation products, like D-dimer, have been associated with death from all causes in healthy individuals and COPD patients. We aimed to determine the (i) association between D-dimer levels and all-cause mortality and time being alive and out of a hospital, (ii) possible modifying effect of anticoagulant treatment, and (iii) distribution of D-dimer in patients with moderate to severe COPD. Methods: Results of routinely measured stable phase D-dimer samples from COPD-outpatients at Copenhagen University Hospital – Herlev and Gentofte, COPD-outpatient clinic were collected using the Danish registries. These were used to examine whether COPD-patients with a D-dimer level in the upper quartile, had a higher risk of death from all causes within 365 days. Results: In the unadjusted Cox proportional hazards regression we found an association between high D-dimer and all-cause mortality: Hazard ratio (HR): 2.3 (95% Confidence Interval (CI) 1.1–4.7). In the fully adjusted regression, the HR was 1.8 (CI 0.8–3.9). We did not find any interaction between D-dimer and anticoagulant or antiplatelet therapy. For the secondary outcome, proportion of days alive and out of hospital in 365 days (pDAOH), the unadjusted multiple linear regression had an association between high D-dimer level and pDAOH: -2.7% points (pp) (CI -3.9 pp - -1.5 pp), which was attenuated to -1,7pp (-2.9pp – -0.4pp) in the fully adjusted regression. Conclusions: In patients with moderate to severe COPD, patients with a high level of D-dimer were more likely to die; however, the signal was not strong in the adjusted analyses and our results do not support unselected risk stratification with D-dimer in COPD-outpatients.

KW - All-cause mortality

KW - Biomarker

KW - Cohort

KW - COPD

KW - D-dimer

U2 - 10.1186/s12931-023-02472-9

DO - 10.1186/s12931-023-02472-9

M3 - Journal article

C2 - 37370121

AN - SCOPUS:85163716091

VL - 24

JO - Respiratory Research (Print)

JF - Respiratory Research (Print)

SN - 1465-9921

M1 - 172

ER -