Differences in systemic inflammation and prethrombotic biomarkers between AECOPD patients with and without pulmonary hypertension.

objectiveThe relationship between inflammatory cytokines and prothrombotic markers with PH during the acute phase of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains unclear. This study aims to compare the profiles of peripheral blood biomarkers in AECOPD patients with and without Pulmonary Hypertension(PH), and to evaluate their diagnostic significance.

methodsWe conducted a case-control study enrolling 148 patients admitted to the Department of Respiratory Medicine at Fuyang First People's Hospital in Hangzhou, Zhejiang Province, China, between January 2023 and April 2025. The patients were categorized into three groups: a control group (n = 49), an AECOPD group (n = 59), and an AECOPD with PH group (n = 40). The clinical characteristics and the relationships between inflammatory cytokines and prothrombotic markers were compared among the three groups. Logistic regression analysis was employed to identify inflammatory biomarkers and prothrombotic markers with independent predictive value. The predictive accuracy of these risk factors was assessed using receiver operating characteristic (ROC) curves.

resultsCompared with healthy volunteers, AECOPD patients showed elevated levels of PIV, SII, IL-8, CRP, NLR, and PLR (p < 0.0001) based on quartile comparisons. Levels of these inflammatory markers were significantly elevated in both AECOPD and AECOPD + PH groups compared to controls (p < 0.0001). However, no significant differences were found between the AECOPD and AECOPD + PH groups. Among the prethrombotic markers, D-dimer and TAT were elevated in AECOPD patients with PH. ROC curve analysis identified PIV, SII, IL-8, CRP, NLR, and PLR as significant predictors of AECOPD. Among the inflammatory markers, SII exhibited the highest area under the curve (AUC) of 0.834 (95% CI: 0.748-0.905). The combination of SII and IL-8 yielded the highest AUC among inflammatory markers, at 0.926 (95% CI: 0.876-0.967). Furthermore, the combination of D‑dimer and TAT resulted in a higher AUC than either marker alone, with an AUC of 0.919 (95% CI: 0.865-0.966) for identifying PH in AECOPD patients.

conclusionAECOPD patients with PH exhibit a distinct biomarker pattern characterized by a plateau in systemic inflammation alongside progressive coagulation activation. We speculate that this may be attributed to a regionalized redistribution of the inflammatory response or functional exhaustion of the immune system. The combination of inflammatory markers (SII and IL-8) and prothrombotic markers (D-dimer and TAT) provides excellent discriminative ability for diagnosing AECOPD and identifying concomitant PH, respectively. These findings support the use of combined biomarker panels for individualized risk assessment and early detection of PH in AECOPD patients. CLINICAL TRIAL REGISTRATION NUMBER: Not suitable.