L-Arginine Pathway in COPD Patients with Acute Exacerbation: A New Potential Biomarker

Figures & data

Table 1. Demographic and clinical data

	Healthy N = 30	AECOPD N = 12	Stable COPD N = 32	p-value
Age, years	51.1 ± 3.4	64.9 ± 9.2	59.3 ± 9.6	0.10
Male (%)	15 (50)	6 (50)	14(44)	0.71
Smoking (%)	6 (20)	4 (33)	8(25)	0.53
CAD (%)	NA	6 (50)	7(22)	0.06
Hypertension (%)	NA	10 (83)	18 (56)	0.17
Diabetes (%)	NA	3 (25)	7 (22)	0.51
Stroke (%)	NA	2 (17)	4 (13)	0.72
ICS therapy	NA	10 (83)	20 (63)	0.19
CRF (%)	NA	7 (58)	9 (28)	0.06
LTOT (%)	NA	5 (42)	8 (25)	0.12
Number of AE in previous year	NA	6 (50)	7 (22)	0.05
CBG pO2, mmHg	NA	52.2 ± 7.2	60.5 ± 11.5	0.02
SpO2%	NA	86 ± 5	89 ± 9	0.45
Creatinine, μmol/l	82.7 ± 13.5	81.2 ± 30.4	73.9 ± 27.6	0.53

Values are presented as mean ± SD or as numbers (relative percentages), respectively (chi-square test and one-way ANOVA test); CAD: coronary artery disease, COPD: chronic obstructive pulmonary disease, AECOPD: COPD with acute exacerbation, ICS: inhaled ­corticosteroid therapy, CRF: chronic respiratory failure (if SpO₂ < 90%) on admission, LTOT: long-term oxygen therapy, AE: acute exacerbation episode, CBG pO₂: partial pressure of oxygen in capillary blood gas, SpO₂: saturation of oxygen measured by pulse oximetry.

Table 2. Serum concentration of the L-arginine pathway metabolites and hsCRP in patients with COPD

	COPD N = 44	Healthy N = 30	p-value
L-arginine, μmol/l	109.5 (96.4–123.8)	84.1 (78.9–91.0)	<0.05
ADMA, μmol/l	0.67 (0.59–0.78)	0.41 (0.38–0.46)	<0.001
SDMA, μmol/l	0.54 (0.43–0.65)	0.36 (0.33–0.39)	<0.001
hsCRP, mg/l	7.8 (4.1–22.7)	3.4 (2.2–7.5)	<0.05
	AECOPD N = 12	Stable COPD N = 32
L-arginine, μmol/l	119.9 (102.7–144.9)	104.7 (91.5–117.9)	0.07
ADMA, μmol/l	0.83 (0.68–0.95)	0.63 (0.57–0.72)	<0.001
SDMA, μmol/l	0.68 (0.60–0.98)	0.46 (0.41–0.56)	<0.001
hsCRP, mg/l	11.9 (4.5–33.8)	7.5 (4.1–21.3)	0.53

COPD: chronic obstructive pulmonary disease, AECOPD: COPD with acute exacerbation, Stable COPD: COPD without acute exacerbation, ADMA: asymmetric dimethylarginine, SDMA: symmetric dimethylarginine, hsCRP: high-sensitivity C-reactive protein. Data are shown as median (25th–75th percentiles). Mann–Whitney U-test.

Figure 1. Serum ADMA levels in COPD patients with and without acute exacerbation compared to healthy subjects. Serum concentration of ADMA (μmol/l) is shown in COPD patients with acute exacerbation (AECOPD), stable COPD and in healthy subjects (HS). Data are presented as mean and 95% confidence interval.

Figure 2. Serum SDMA levels in COPD patients with and without acute exacerbation compared to healthy subjects. Serum concentration of SDMA (μmol/l) is shown in COPD patients with acute exacerbation (AECOPD), stable COPD and in healthy subjects (HS). Data are presented as mean and 95% confidence interval.

Figure 3. Serum L-arginine levels in COPD patients with and without acute exacerbation compared to healthy subjects. Serum concentration of L-arginine (μmol/l) is shown in COPD patients with acute exacerbation (AECOPD), stable COPD and in healthy subjects (HS). Data are presented as mean and 95% confidence interval.

Figure 4. Correlation between partial capillary oxygen pressure and ADMA in patients with COPD. Correlation between partial capillary oxygen pressure (mmHg) and serum concentration of ADMA (μmol/l) is shown in COPD patients. (Pearson correlation, r = -0.34, p < 0.05, scatter plot diagram).

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