The application value of fibrinogen and other serological indicators in the management of patients with bronchiectasis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Yuanyuan ^1,2 , ZHAO Tingting ¹ ,  SU Xin ^1,2

1. Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210000, P. R. China;
2. Department of Respiratory and Critical Care Medicine, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210000, China;

Corresponding author：

SU Xin, Email: suxinjs@163.com

Keywords：

Bronchiectasis; fibrinogen; pulmonary function; management

DOI：

10.7507/1671-6205.202403059

Video：

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Objective To investigate the application value of fibrinogen and other serological indicators in the management of patients with bronchiectasis. Methods Basic information, serological indicators such as blood routine items, biochemical, blood coagulation, and inflammation index of 121 patients with bronchiectasis in Nanjing Jinling Hospital and Nanjing Drum Tower Hospital from July 2021 to June 2023 were collected. The value of fibrinogen and other serological indicators in identifying patients with acute exacerbation and severely impaired lung function (FEV₁%pred<60%) was evaluated. Results The levels of leukocytes, neutrophils, platelets, C-reactive protein and fibrinogen were higher in the patients with acute exacerbation and in the FEV₁%pred<60% group, negatively correlated with FEV₁%pred. While the level of albumin was higher in the patients of the stable group and FEV₁%pred≥60% group, and positively correlated with FEV₁%pred. Compared with leukocytes, neutrophils, platelets, C-reactive protein and albumin, fibrinogen demonstrated the best recognition ability for the patients with FEV₁%pred<60% (AUC=0.839). The sensitivity of identifying patients with FEV₁%pred<60% was 91.18% and the specificity was 71.26% when the level of fibrinogen was over 3.35 g/L. Conclusions Leukocytes, neutrophils, platelets, C-reactive protein, albumin and fibrinogen have shown certain application value in recognition of patients with bronchiectasis in acute exacerbation stage and FEV₁%pred<60%. These serological indicators may be helpful in precision treatment and individual management of patients with bronchiectasis.

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2.	Aliberti S, Goeminne PC, O'Donnell AE, et al. Criteria and definitions for the radiological and clinical diagnosis of bronchiectasis in adults for use in clinical trials: international consensus recommendations. Lancet Respir Med, 2022, 10(3): 298-306.
3.	Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J, 2016, 47(1): 186-193.
4.	Ringshausen FC, Rademacher J, Pink I, et al. Increasing bronchiectasis prevalence in Germany, 2009-2017: a population-based cohort study. Eur Respir J, 2019, 54(6): 1900499.
5.	Aliberti S, Sotgiu G, Lapi F, et al. Prevalence and incidence of bronchiectasis in Italy. BMC Pulm Med, 2020, 20(1): 15.
6.	Choi H, Yang B, Nam H, et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J, 2019, 54(2): 1900194.
7.	Lin JL, Xu JF, Qu JM. Bronchiectasis in China. Ann Am Thorac Soc, 2016, 13(5): 609-616.
8.	Feng J, Sun L, Sun X, et al. Increasing prevalence and burden of bronchiectasis in urban Chinese adults, 2013-2017: a nationwide population-based cohort study. Respir Res, 2022, 23(1): 111.
9.	Athanazio RA. Bronchiectasis: moving from an orphan disease to an unpleasant socioeconomic burden. ERJ Open Res, 2021, 7(4): 00507-2021.
10.	Goeminne PC, Hernandez F, Diel R, et al. The economic burden of bronchiectasis-known and unknown: a systematic review. BMC Pulm Med, 2019, 19(1): 54.
11.	Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med, 2014, 189(5): 576-585.
12.	Martinez-Garcia MA, Athanazio RA, Giron R, et al. Predicting high risk of exacerbations in bronchiectasis: the E-FACED score. Int J Chron Obstruct Pulmon Dis, 2017, 12: 275-284.
13.	Oriano M, Gramegna A, Terranova L, et al. Sputum neutrophil elastase associates with microbiota and Pseudomonas aeruginosa in bronchiectasis. Eur Respir J, 2020, 56(4): 2000769.
14.	Good W, Jeon G, Zeng I, et al. Sputum procalcitonin: a potential biomarker in stable bronchiectasis. ERJ Open Res, 2021, 7(4): 00285-2021.
15.	Sibila O, Perea L, Canto E, et al. Antimicrobial peptides, disease severity and exacerbations in bronchiectasis. Thorax, 2019, 74(9): 835-842.
16.	Sibila O, Laserna E, Shoemark A, et al. Airway bacterial load and inhaled antibiotic response in Bronchiectasis. Am J Respir Crit Care Med, 2019, 200(1): 33-41.
17.	Chalmers JD, Aliberti S, Filonenko A, et al. Characterization of the “Frequent Exacerbator Phenotype” in Bronchiectasis. Am J Respir Crit Care Med, 2018, 197(11): 1410-1420.
18.	支气管扩张症专家共识撰写协作组, 中华医学会呼吸病学分会感染学组. 中国成人支气管扩张症诊断与治疗专家共识. 中华结核和呼吸杂志, 2021, 44(4): 311-321.
19.	Martinez-Garcia MA, Olveira C, Giron R, et al. Peripheral neutrophil-to-lymphocyte ratio in bronchiectasis: a marker of disease severity. Biomolecules, 2022, 12(10): 1399.
20.	Sibila O, Laserna E, Shoemark A, et al. Heterogeneity of treatment response in bronchiectasis clinical trials. Eur Respir J, 2022, 59(5): 2100777.
21.	Hill AT, Haworth CS, Aliberti S, et al. Pulmonary exacerbation in adults with bronchiectasis: a consensus definition for clinical research. Eur Respir J, 2017, 49(6): 1700051.
22.	Garcia-Rio F, Alcazar-Navarrete B, Castillo-Villegas D, et al. Biological biomarkers in respiratory diseases. Arch Bronconeumol, 2022, 58(4): 323-333.
23.	Chang AB, Bush A, Grimwood K. Bronchiectasis in children: diagnosis and treatment. Lancet, 2018, 392(10150): 866-879.
24.	Gregson EC. Which antibiotics should be used to treat children with an acute exacerbation of bronchiectasis and as long-term prevention of exacerbations? Arch Dis Child, 2019, 104(10): 1013-1016.
25.	张远骋. 支气管扩张患者急性加重期后的心血管事件研究. 中国呼吸与危重监护杂志, 2023, 22(9): 634-639.
26.	Navaratnam V, Forrester DL, Eg KP, et al. Paediatric and adult bronchiectasis: Monitoring, cross-infection, role of multidisciplinary teams and self-management plans. Respirology, 2019, 24(2): 115-126.
27.	Amaro R, Perea L, Sibila O. Future directions in bronchiectasis research. Clin Chest Med, 2022, 43(1): 179-187.
28.	杨丽青, 杨小东, 杨凌婧, 等. 支气管扩张患者急性加重危险因素分析. 中国呼吸与危重监护杂志, 2020, 19(6): 543-547.
29.	Martinez-Garcia MA, Oscullo G, Posadas T, et al. Pseudomonas aeruginosa and lung function decline in patients with bronchiectasis. Clin Microbiol Infect, 2021, 27(3): 428-434.
30.	Mosesson MW. Fibrinogen and fibrin structure and functions. J Thromb Haemost, 2005, 3(8): 1894-1904.
31.	Rathore SS, Oberoi S, Iqbal K, et al. Prognostic value of novel serum biomarkers, including C-reactive protein to albumin ratio and fibrinogen to albumin ratio, in COVID-19 disease: a meta-analysis. Rev Med Virol, 2022, 32(6): e2390.
32.	Serban KA, Pratte KA, Bowler RP. Protein biomarkers for COPD outcomes. Chest, 2021, 159(6): 2244-2253.
33.	Fermont JM, Masconi KL, Jensen MT, et al. Biomarkers and clinical outcomes in COPD: a systematic review and meta-analysis. Thorax, 2019, 74(5): 439-446.
34.	Zhou B, Liu S, He D, et al. Fibrinogen is a promising biomarker for chronic obstructive pulmonary disease: evidence from a meta-analysis. Biosci Rep, 2020, 40(7): BSR20193542.
35.	Hu X, Xu J, Li P, et al. Correlation of serum clara cell secretory protein 16, plasma fibrinogen and serum amyloid A with the severity of acute exacerbated COPD and their combination in prognosis assessment. Int J Chron Obstruct Pulmon Dis, 2023, 18: 1949-1957.
36.	Miller BE, Tal-Singer R, Rennard SI, et al. Plasma fibrinogen qualification as a drug development Tool in chronic obstructive pulmonary disease. Perspective of the chronic obstructive pulmonary disease biomarker qualification consortium. Am J Respir Crit Care Med, 2016, 193(6): 607-613.
37.	Di Micco P, Russo V, Carannante N, et al. Prognostic value of fibrinogen among COVID-19 patients admitted to an emergency department: an Italian cohort study. J Clin Med, 2020, 9(12): 4134.
38.	Saleh AD, Chalmers JD, De Soyza A, et al. The heterogeneity of systemic inflammation in bronchiectasis. Respir Med, 2017, 127: 33-39.
39.	Lee SJ, Jeong JH, Heo M, et al. Serum fibrinogen as a biomarker for disease severity and exacerbation in patients with non-cystic fibrosis bronchiectasis. J Clin Med, 2022, 11(14): 3948.

1. O'Donnell AE. Bronchiectasis-a clinical review. N Engl J Med, 2022, 387(6): 533-545.
2. Aliberti S, Goeminne PC, O'Donnell AE, et al. Criteria and definitions for the radiological and clinical diagnosis of bronchiectasis in adults for use in clinical trials: international consensus recommendations. Lancet Respir Med, 2022, 10(3): 298-306.
3. Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J, 2016, 47(1): 186-193.
4. Ringshausen FC, Rademacher J, Pink I, et al. Increasing bronchiectasis prevalence in Germany, 2009-2017: a population-based cohort study. Eur Respir J, 2019, 54(6): 1900499.
5. Aliberti S, Sotgiu G, Lapi F, et al. Prevalence and incidence of bronchiectasis in Italy. BMC Pulm Med, 2020, 20(1): 15.
6. Choi H, Yang B, Nam H, et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J, 2019, 54(2): 1900194.
7. Lin JL, Xu JF, Qu JM. Bronchiectasis in China. Ann Am Thorac Soc, 2016, 13(5): 609-616.
8. Feng J, Sun L, Sun X, et al. Increasing prevalence and burden of bronchiectasis in urban Chinese adults, 2013-2017: a nationwide population-based cohort study. Respir Res, 2022, 23(1): 111.
9. Athanazio RA. Bronchiectasis: moving from an orphan disease to an unpleasant socioeconomic burden. ERJ Open Res, 2021, 7(4): 00507-2021.
10. Goeminne PC, Hernandez F, Diel R, et al. The economic burden of bronchiectasis-known and unknown: a systematic review. BMC Pulm Med, 2019, 19(1): 54.
11. Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med, 2014, 189(5): 576-585.
12. Martinez-Garcia MA, Athanazio RA, Giron R, et al. Predicting high risk of exacerbations in bronchiectasis: the E-FACED score. Int J Chron Obstruct Pulmon Dis, 2017, 12: 275-284.
13. Oriano M, Gramegna A, Terranova L, et al. Sputum neutrophil elastase associates with microbiota and Pseudomonas aeruginosa in bronchiectasis. Eur Respir J, 2020, 56(4): 2000769.
14. Good W, Jeon G, Zeng I, et al. Sputum procalcitonin: a potential biomarker in stable bronchiectasis. ERJ Open Res, 2021, 7(4): 00285-2021.
15. Sibila O, Perea L, Canto E, et al. Antimicrobial peptides, disease severity and exacerbations in bronchiectasis. Thorax, 2019, 74(9): 835-842.
16. Sibila O, Laserna E, Shoemark A, et al. Airway bacterial load and inhaled antibiotic response in Bronchiectasis. Am J Respir Crit Care Med, 2019, 200(1): 33-41.
17. Chalmers JD, Aliberti S, Filonenko A, et al. Characterization of the “Frequent Exacerbator Phenotype” in Bronchiectasis. Am J Respir Crit Care Med, 2018, 197(11): 1410-1420.
18. 支气管扩张症专家共识撰写协作组, 中华医学会呼吸病学分会感染学组. 中国成人支气管扩张症诊断与治疗专家共识. 中华结核和呼吸杂志, 2021, 44(4): 311-321.
19. Martinez-Garcia MA, Olveira C, Giron R, et al. Peripheral neutrophil-to-lymphocyte ratio in bronchiectasis: a marker of disease severity. Biomolecules, 2022, 12(10): 1399.
20. Sibila O, Laserna E, Shoemark A, et al. Heterogeneity of treatment response in bronchiectasis clinical trials. Eur Respir J, 2022, 59(5): 2100777.
21. Hill AT, Haworth CS, Aliberti S, et al. Pulmonary exacerbation in adults with bronchiectasis: a consensus definition for clinical research. Eur Respir J, 2017, 49(6): 1700051.
22. Garcia-Rio F, Alcazar-Navarrete B, Castillo-Villegas D, et al. Biological biomarkers in respiratory diseases. Arch Bronconeumol, 2022, 58(4): 323-333.
23. Chang AB, Bush A, Grimwood K. Bronchiectasis in children: diagnosis and treatment. Lancet, 2018, 392(10150): 866-879.
24. Gregson EC. Which antibiotics should be used to treat children with an acute exacerbation of bronchiectasis and as long-term prevention of exacerbations? Arch Dis Child, 2019, 104(10): 1013-1016.
25. 张远骋. 支气管扩张患者急性加重期后的心血管事件研究. 中国呼吸与危重监护杂志, 2023, 22(9): 634-639.
26. Navaratnam V, Forrester DL, Eg KP, et al. Paediatric and adult bronchiectasis: Monitoring, cross-infection, role of multidisciplinary teams and self-management plans. Respirology, 2019, 24(2): 115-126.
27. Amaro R, Perea L, Sibila O. Future directions in bronchiectasis research. Clin Chest Med, 2022, 43(1): 179-187.
28. 杨丽青, 杨小东, 杨凌婧, 等. 支气管扩张患者急性加重危险因素分析. 中国呼吸与危重监护杂志, 2020, 19(6): 543-547.
29. Martinez-Garcia MA, Oscullo G, Posadas T, et al. Pseudomonas aeruginosa and lung function decline in patients with bronchiectasis. Clin Microbiol Infect, 2021, 27(3): 428-434.
30. Mosesson MW. Fibrinogen and fibrin structure and functions. J Thromb Haemost, 2005, 3(8): 1894-1904.
31. Rathore SS, Oberoi S, Iqbal K, et al. Prognostic value of novel serum biomarkers, including C-reactive protein to albumin ratio and fibrinogen to albumin ratio, in COVID-19 disease: a meta-analysis. Rev Med Virol, 2022, 32(6): e2390.
32. Serban KA, Pratte KA, Bowler RP. Protein biomarkers for COPD outcomes. Chest, 2021, 159(6): 2244-2253.
33. Fermont JM, Masconi KL, Jensen MT, et al. Biomarkers and clinical outcomes in COPD: a systematic review and meta-analysis. Thorax, 2019, 74(5): 439-446.
34. Zhou B, Liu S, He D, et al. Fibrinogen is a promising biomarker for chronic obstructive pulmonary disease: evidence from a meta-analysis. Biosci Rep, 2020, 40(7): BSR20193542.
35. Hu X, Xu J, Li P, et al. Correlation of serum clara cell secretory protein 16, plasma fibrinogen and serum amyloid A with the severity of acute exacerbated COPD and their combination in prognosis assessment. Int J Chron Obstruct Pulmon Dis, 2023, 18: 1949-1957.
36. Miller BE, Tal-Singer R, Rennard SI, et al. Plasma fibrinogen qualification as a drug development Tool in chronic obstructive pulmonary disease. Perspective of the chronic obstructive pulmonary disease biomarker qualification consortium. Am J Respir Crit Care Med, 2016, 193(6): 607-613.
37. Di Micco P, Russo V, Carannante N, et al. Prognostic value of fibrinogen among COVID-19 patients admitted to an emergency department: an Italian cohort study. J Clin Med, 2020, 9(12): 4134.
38. Saleh AD, Chalmers JD, De Soyza A, et al. The heterogeneity of systemic inflammation in bronchiectasis. Respir Med, 2017, 127: 33-39.
39. Lee SJ, Jeong JH, Heo M, et al. Serum fibrinogen as a biomarker for disease severity and exacerbation in patients with non-cystic fibrosis bronchiectasis. J Clin Med, 2022, 11(14): 3948.

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Latest ArticlesThe application value of fibrinogen and other serological indicators in the management of patients with bronchiectasis

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