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Published online before print September 17, 2008, 10.1183/09031936.00153207
Eur Respir J 2008; 32:1451-1457
Copyright ©ERS Journals Ltd 2008
doi: 10.1183/09031936.00153207

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Circulating fibronectin to C-reactive protein ratio and mortality: a biomarker in COPD?

S. F. P. Man, L. Xing, J. E. Connett, N. R. Anthonisen, R. A. Wise, D. P. Tashkin, X. Zhang, R. Vessey, T. G. Walker, B. R. Celli and D. D. Sin

For affiliations, please see the Acknowledgements section.

CORRESPONDENCE: D. D. Sin, James Hogg iCAPTURE Center, 1081 Burrard Street, Vancouver, BC V6Z 1Y7, Canada. Fax: 1 6048069274. E-mail: dsin{at}mrl.ubc.ca

Keywords: Chronic obstructive pulmonary disease, C-reactive protein, fibronectin, inflammation, mortality, repair

Received: November 14, 2007
Accepted August 27, 2008

The balance between inflammatory and repair processes is important in maintaining lung homeostasis in chronic obstructive pulmonary disease (COPD). The aim of the present study was to determine whether or not an integrated index of a biomarker involved in inflammation, C-reactive protein (CRP), and another involved in wound repair, fibronectin, may be a good measure to predict clinical outcomes in COPD.

Circulating blood levels of CRP and fibronectin were measured in 4,787 individuals with mild-to-moderate COPD who were prospectively followed for >7 yrs after blood collection as part of the Lung Health Study. To assess the balance between repair and inflammation, a simple ratio was calculated by dividing fibronectin levels by CRP levels and a Cox proportional hazards model was used to determine the relationship between this ratio and all-cause and disease-specific causes of mortality.

The relationship between the fibronectin to CRP ratio and all-cause mortality was L-shaped. There was an exponential decay in the adjusted hazard function (i.e. the risk of mortality) as the ratio decreased until a value of 148 was reached, beyond which point the hazard function did not change significantly. Similar results were observed for the risk of coronary and cardiovascular mortality.

Circulating fibronectin to CRP ratio is significantly associated with all-cause mortality of COPD patients. However, in contrast to other biomarkers, the relationship appears to be L-shaped (and not linear), suggesting a threshold at ~150. While promising, future studies are needed to validate this simple index as a biomarker in COPD.




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