Table 1

Summary of the literature assessing a relationship between fibrinogen and chronic obstructive pulmonary disease (COPD)

Author, yearRefPatientsFindings
Risk of COPDDahl, 2001118955 individuals from the general Danish populationInverse relationship between baseline fibrinogen and FEV1 % predicted. Higher fibrinogen associated with faster lung function decline
Valvi, 20121220 192 individuals from general US population; ARIC/CHS cohortsHigher baseline fibrinogen associated with incident COPD, COPD hospitalisation and all-cause mortality
Engstrom, 2009135247 randomly selected men from Cardiovascular Screening StudyBaseline fibrinogen associated with COPD exacerbation hospital admissions during 25-year follow-up period
Kalhan, 2010142132 individuals from CARDIA studyHigher fibrinogen levels at year 7 associated with greater loss of FEV1 and FVC, but not FEV1:FVC ratio, between year 5 and year 20
Jiang, 2008155011 individuals >65 years old from CHSHigher baseline fibrinogen associated with lower FEV1 % predicted and FEV1:FVC and faster decline in FEV1
Diagnosis and disease severityAlessandri, 19941637 individuals with COPD, 30 controlsFibrinogen higher in patients with COPD (p=0.0005) independent of smoking status
Eickhoff, 20081760 individuals with stable COPD, 20 healthy smokers, 20 healthy non-smokersHigher fibrinogen in individuals with COPD compared with non-smoking controls. No association with disease severity
Mannino, 20031815 697 individuals from NHANES III studyFibrinogen higher in patients with COPD. Association with disease severity in moderate and severe disease
Gan, 200419Meta-analysis comprising four studies and >9000 individualsFibrinogen higher in patients with COPD; standardised mean difference 0.37 g/litre between patients with COPD and controls
Garcia-Rio, 201020324 individuals with COPD and 110 controls from EPI-SCAN cohortFibrinogen associated with diagnosis of COPD in crude data; significance lost once adjustments made for covariates. In individuals with COPD, association between fibrinogen and MRC dyspnoea score, 6 min walk distance. No association with GOLD stage
MortalityDanesh, 200521Meta-analysis. 154 211 individuals from 31 studiesAssociation between fibrinogen and vascular and non-vascular mortality. Fibrinogen associated with death from COPD (HR 3.7 per 1 g/litre increase in fibrinogen)
Mannino, 2012228507 individuals from NHANES III studyAssociation between fibrinogen level and all-cause mortality. Individuals with GOLD stage 3 or 4 disease have higher fibrinogen than GOLD stage 1 or 2 disease
Disease ProgressionDonaldson, 200523148 individuals with COPD (median FEV1 38%)Fibrinogen increased over time. Higher baseline level associated with faster decline in FEV1
Higashimoto, 20092473 Japanese individuals with COPD (median FEV1 70% predicted)Trend towards faster decline in lung function in those with higher fibrinogen (p=0.054)
Vestbo, 2011251793 individuals with COPDFibrinogen associated with FEV1 at baseline but no association seen with annual decline in FEV1
Components of COPDPapaioannou, 20102649 individuals with stable COPDFibrinogen higher in individuals with emphysema than those without
Hurst, 2010272138 individuals with COPD from the ECLIPSE cohortHigher fibrinogen levels are associated with an increased rate of exacerbations in those with GOLD stage II disease
Wedzicha, 20002893 individuals with moderate to severe COPDFibrinogen increased during acute exacerbation and is significantly higher in the presence of purulent sputum, a symptomatic cold or increased cough
Groenewegen, 200829314 individuals with COPD from the COSMIC studyHigher fibrinogen associated with higher rate of moderate and severe exacerbations
Mackay, 201230161 individuals with COPDCAT scores are higher at baseline in frequent exacerbators and are linked to fibrinogen levels
Banerjee, 20043167 individuals with stable moderate to severe COPDBacterial or viral airway colonisation associated with higher fibrinogen levels
Seemungal, 200132120 individuals with COPDHigher fibrinogen in patients with RSV-positive stable COPD. Trend towards higher fibrinogen during exacerbation if RSV detectable vs undetectable
ExacerbationsPolalti, 20083333 individuals with stable COPD, 26 individuals with acute exacerbations, 16 controlsFibrinogen levels higher in COPD than controls and significantly higher during an exacerbation of COPD than in stable disease
Saldias, 20113485 individual with mild to moderate exacerbation of COPDFibrinogen levels are higher during exacerbations and return to baseline after 30 days
Koutsokera, 20093530 individuals with an acute exacerbation of COPDFibrinogen levels return to baseline 40 days after exacerbation but baseline levels do not predict recovery time
Valipour, 20083630 individuals with stable COPD, 30 individuals with acute exacerbations, 30 controlsFibrinogen levels higher in individuals with COPD versus controls. No difference in fibrinogen between stable COPD and exacerbation but significant reduction in fibrinogen during 6-week recovery period following an exacerbation
Co-morbiditiesJousilahti, 19963719444 Finish men from the general populationSymptoms of chronic bronchitis predict the risk of developing coronary heart disease
Fowkes, 20063889 individuals with AAAIndividuals with AAA more likely to have COPD and higher fibrinogen levels than those without. Association between lung function, COPD and AAA only marginally affected by smoking history and concurrent cardiovascular disease but substantially affected by composite markers of inflammatory disease
Castagna, 200839151 individuals with stable COPD, 31 smoker controls, 42 non-smoker controlsPVD is more prevalent in individuals with COPD than healthy controls
Blum, 20114027 individuals with COPD, 60 individuals with COPD and PVDIndividuals with COPD and PVD are more likely to have lower BMI and be older
Maksimovic, 201241388 individuals with PVDMore severe PVD is associated with higher fibrinogen levels
McDermott, 200542107 individuals over 60 years with PVD, 848 controls over 60 yearsPVD is associated with higher fibrinogen levels
Watz, 200943170 individuals with stable COPD, 30 individuals with chronic bronchitis47.5% of individuals with chronic bronchitis/COPD have metabolic syndrome. Fibrinogen not associated with metabolic syndrome but does reflect level of physical activity
Waschki, 201244127 people with COPD, 44 healthy controlsPhysical activity is associated with FEV1 and is inversely associated with fibrinogen
Watz, 200845170 individuals with stable COPDHigh fibrinogen levels and cardiac dysfunction are associated with reduced physical activity
Waschki, 201146170 individuals with stable COPDFibrinogen is increased in non-survivors but is not associated with the risk of death. Physical activity is correlated with FEV1 and is inversely associated with fibrinogen level
GeneticsYanbeava, 200947355 individuals with stable moderate to severe COPD, 195 healthy smokersNo single nucleotide polymorphisms in fibrinogen associated with the presence of COPD
TreatmentsLomas, 20094889 individuals with stable COPDNo change in fibrinogen level following a 6-week course of oral prednisolone
Lomas, 201149294 individuals with stable COPDTreatment with inhaled steroid does not affect fibrinogen. The p38 MAPK inhibitor losmapimod reduces fibrinogen levels by 11% after a 12-week treatment (p=0.002)
Kunter, 20085030 individuals with acute exacerbations of COPDTreatment of acute exacerbation with intravenous methylprednisolone results in a significant decrease in fibrinogen after 10 days; no effect in non-steroid treated group
Barnes, 20095171 individuals with stable COPD: 34 treated, 37 controlsThe p38 MAPK inhibitor SB-681323 reduces fibrinogen levels by 11% after a 28-day treatment (p=0.02)
Dentener, 20085216 individuals with COPD: 8 treated, 8 controls6 weeks' treatment with infliximab (anti-TNFα) does not alter fibrinogen levels
Kaczmarek, 20105356 individuals with stable COPD: 28 treated, 28 controlsNo significant difference in fibrinogen levels after 3 months' treatment with simvastatin
  • AAA, abdominal aortic aneurysm; ARIC, Atherosclerosis Risk in Communities; BMI, body mass index; CARDIA, Coronary Artery Risk Development in Young Adults; CAT, COPD Assessment Test; CHS, Cardiovascular Health Study; COSMIC, COPD and Seretide: a Multi-Center Intervention and Characterization; EPI-SCAN, Epidemiologic Study of COPD in Spain; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; GOLD, Global Initiative on Obstructive Lung Disease; MAPK, mitogen-activated protein kinase; MRC, Medical Research Council; NHANES III, Third National Health and Nutrition Examination Survey; PVD, peripheral vascular disease; RSV, respiratory syncytial virus; TNF, tumour necrosis factor.