Elevated Tissue Factor and TFPI Levels in Acute COPD Exacerbations: A Prospective Comparison With Stable COPD and Healthy Controls.

PurposeThis prospective study aimed to evaluate tissue factor (TF) and tissue factor pathway inhibitor (TFPI) as potential biomarkers of hypercoagulability in patients with acute exacerbation of COPD (AECOPD), compared to stable COPD patients and healthy controls.Patients and methods30 patients with AECOPD, 30 stable COPD patients, and 30 healthy controls were enrolled from April 2021 to September 2022 at the Department of Respiratory Medicine and Critical Care Medicine, Wusong Central Hospital in Baoshan District, Shanghai, China. Clinical data, serum levels of TF, TFPI, inflammatory markers, and coagulation parameters were collected. Pearson correlation analysis was performed to examine the relationships between TF, TFPI, inflammatory markers, and components of the coagulation-fibrinolysis system in patients with AECOPD.ResultsSerum levels of TF, TFPI, C-reactive protein, interleukin-8, and tumor necrosis factor-alpha were significantly elevated in the acute exacerbation group compared to both the stable and control groups (p < 0.05). No significant differences in D-dimer and prothrombin time were observed between the acute exacerbation and stable groups. In AECOPD patients, IL-8 was negatively correlated with FEV1FVC (r = -0.425, p = 0.019) and positively correlated with arterial partial pressure of oxygen (PO2) (r = 0.489, p = 0.006); TNF-α was negatively correlated with TF (r = -0.521, p = 0.003) and PT (r = -0.369, p = 0.045); TFPI was positively correlated with hemoglobin (Hb) (r = 0.488, p = 0.006).ConclusionElevated circulating TF and TFPI antigen levels during AECOPD reflect a prothrombotic profilerather than direct evidence of functional hypercoagulability; these biomarkers show greater sensitivity than conventional markers (D-dimer, PT) in capturing coagulation-inflammation perturbations in AECOPD.