Endothelial injury in Chronic Obstructive Pulmonary Disease assessed by microalbuminuria (MAB) and von Willebrand factor levels and activity

Introduction: There is evidence for endothelial dysfunction in patients with COPD. Aims: The aim of the present study was to compare the presence of MAB as well as serum von Willebrand factor levels (vWf Ag) and activity (vWf Ac), between patients with clinically stable COPD and smokers without airway obstruction. Methods: 84 outpatients with stable COPD and 32 smokers of more than 10-pack-years without airway obstruction, served as the control group, were included in the study. Results: Presence of MAB was significantly greater in patients with COPD than in the control group: 26.1% vs. 9%, P: 0.047. Patients with COPD had significantly higher levels of MAB than controls: (median - IQR) 15.22 (0.59-29.85) vs. 12.08 (8.51-15.64) mg/g, P:0.002. Levels of MAB were higher in patients with COPD Assessment Test (CAT) score ≥10 compared to those with CAT score l10, P:0.011 and those with FEV1l50% predicted compared to those with FEV1≥50% predicted, P=0.049. Serum vWf Ac and vWf Ag were both significantly higher in the COPD group compared to the control group: 150 (118.5-181.5) vs 108.5 (87-130), Pl0.001 and 141 (112.5-169.5) vs 113 (89.5-136.5), Pl0.001, respectively. In COPD patients, both serum vWf Ac and vWf Ag differed among ABCD groups (P:0.004 and 0.005 respectively), with the highest levels and activity in group D. MAB was not correlated with levels of wVfAc or wVfAg. Cardiovascular risk, as assessed by HEART score, was not different between the two groups, P=0.249. Conclusions: We have found strong evidence of endothelial injury among COPD patients, reflected by increased incidence of MAB as well as elevated levels of wVf Ac and wVf Ag compared to controls. In addition, we have found significant associations of MAB, serum vWf Ag and vWf Ac with the 2020 GOLD stages and low FEV1 values.