LABORATORY MARKERS OF THE SEVERITY OF CHRONIC OBSTRUCTIVEPULMONARY DISEASE
DOI:
https://doi.org/10.11603/mcch.2410-681X.2026.i3.16602Keywords:
chronic obstructive pulmonary disease; lung function; complete blood count; systemic inflammatory response; C-reactive protein; fibrinogenAbstract
Introduction. Chronic obstructive pulmonary disease (COPD) remains one of the leading causes of morbidity and mortality worldwide, and the global burden of this disease continues to grow: according to projections, the prevalence of COPD could reach 600 million cases by 2050, which is 23 % higher than the 2020 figures. This underscores the urgent need to identify accessible, reproducible, and cost-effective tools for assessing disease severity. The aim of the study was to evaluate the dynamics of complete blood count parameters and systemic markers of inflammation depending on the stage of COPD (according to GOLD) to determine their diagnostic and prognostic significance as indicators of the severity and progression of the systemic inflammatory response. Research Methods. The study included 100 patients with COPD who were receiving inpatient or outpatient treatment. The diagnosis of COPD was established in accordance with the recommendations of the Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2024) based on clinical manifestations, medical history, and spirometry results. Complete blood count (CBC) parameters were measured using an HA3 automated hematology analyzer from BioSystems (Spain). Erythrocyte sedimentation rate (ESR) was determined using the Westergren method. C-reactive protein (CRP) concentration was determined by immunoturbidimetry on a Cobas c 311 biochemical analyzer (Roche Diagnostics, Switzerland). Fibrinogen levels were measured using the Klaus method on a Sysmex CA-1500 automated coagulometer (Sysmex Corporation, Japan). Statistical analysis of the results was performed using Statistica 13.0 software. Results and Discussion. In patients with COPD, complete blood count parameters undergo phenotypically divergent but predictable changes depending on the stage of the disease: the counts of red blood cells, white blood cells, and platelets increase significantly (p < 0.001), reflecting compensatory erythrocytosis against a background of chronic hypoxia, an increase in systemic inflammation, and the activation of a prothrombotic state, whereas hemoglobin concentration does not change in a statistically significant manner (p = 0.061), indicating a balance between hypoxic stimulation of erythropoiesis and the inhibitory effect of inflammation. The progression of COPD is accompanied by a statistically significant increase in the systemic inflammatory response: ESR, CRP, and fibrinogen levels rise progressively (p < 0.001 for all parameters), with the most pronounced and consistent trend observed in C-reactive protein (CRP), confirming its leading role as a marker of the severity and progression of chronic inflammation in COPD. Conclusions. The obtained data support the feasibility of using these parameters in combination as an accessible tool for assessing the severity and monitoring the progression of COPD.
References
1. Boers, E., Barrett, M., Su, J. G., Benjafield, A. V., Sinha, S., Kaye, L., et al. (2023). Global burden of chronic obstructive pulmonary disease through 2050. JAMA Network Open, 6 (12), e2346598. https://doi.org/10.1001/jamanetworkopen.2023.46598 DOI: https://doi.org/10.1001/jamanetworkopen.2023.46598
2. Sharma, M., Joshi, S., Banjade, P., Ghamande, S. A., & Surani, S. (2024). Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 guidelines reviewed. The Open Respiratory Medicine Journal, 18, e18743064279064. https://doi.org/10.2174/0118743064279064231227070344 DOI: https://doi.org/10.2174/0118743064279064231227070344
3. Hegde, M., Raj, S., Pattanshetti, A. S., & Nyamagoud, S. B. (2025). Gaining insights into chronic obstructive pulmonary disease exacerbation through emerging biomarkers and the chronic obstructive pulmonary disease assessment test score. Monaldi Archives for Chest Disease, 95 (1), 2955. https://doi.org/10.4081/monaldi.2024.2955 DOI: https://doi.org/10.4081/monaldi.2024.2955
4. Doğan, S., Demirtakan, T., Bala, E. D., Basa Kalafat, A. F., Avşaroğlu, M. K., Yazıcı, R., et al. (2025). Comparison of the value of different biomarkers as diagnostic and prognostic markers in AECOPD. Signa Vitae, 21 (5), 86–95. https://doi.org/10.22514/sv.2025.070 DOI: https://doi.org/10.22514/sv.2025.070
5. Fang, L., Zhu, J., & Fu, D. (2025). Predictive value of neutrophil-lymphocyte ratio for all-cause mortality in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. BMC Pulmonary Medicine, 25 (1), 206. https://doi.org/10.1186/s12890-025-03677-y DOI: https://doi.org/10.1186/s12890-025-03677-y
6. Feng, X., Xiao, H., Duan, Y., Li, Q., & Ou, X. (2023). Prognostic value of neutrophil-to-lymphocyte ratio for predicting 90-day poor outcomes in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 18, 1219–1230. https://doi.org/10.2147/COPD.S399671 DOI: https://doi.org/10.2147/COPD.S399671
7. Dimic-Janjic, S., et al. (2025). Utility of neutrophil-tolymphocyte ratio in the prediction of inflammation severity and mortality in chronic obstructive pulmonary disease. Journal of Infection in Developing Countries, 19 (5), 776–781. DOI: https://doi.org/10.3855/jidc.20466
8. Hlapčić, I., Dugac, A. V., Popović-Grle, S., Markelić, I., Rako, I., Rogić, D., & Rumora, L. (2022). Influence of disease severity, smoking status and therapy regimes on leukocyte subsets and their ratios in stable chronic obstructive pulmonary disease. Archives of Medical Science, 18, 672–681.
9. Agustí, A., Celli, B. R., Criner, G. J., Halpin, D. M. G., Anzueto, A., Barnes, P., et al. (2023). Global Initiative for Chronic Obstructive Lung Disease 2023 report. European Respiratory Journal, 61 (4), 2300239. DOI: https://doi.org/10.1183/13993003.00239-2023
10. Celli, B. R., Fabbri, L. M., Aaron, S. D., Agustí, A., Brook, R., Criner, G. J., et al. (2021). An updated definition and severity classification of COPD exacerbations. The Lancet Respiratory Medicine, 9 (2), e20–e21.
11. Barnes, P. J. (2016). Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. Journal of Allergy and Clinical Immunology, 138(1), 16–27. DOI: https://doi.org/10.1016/j.jaci.2016.05.011
12. John, M., Hoernig, S., Doehner, W., Okonko, D. D., Witt, C., & Anker, S.D. (2018). Anemia and inflammation in chronic obstructive pulmonary disease. Chest, 153(2), 403–412.
13. Sarkar, M., Rajta, P. N., & Khatana, J. (2015). Anemia in Chronic obstructive pulmonary disease: Prevalence, pathogenesis, and potential impact. Lung India: official organ of Indian Chest Society, 32 (2), 142–151. https://doi.org/10.4103/0970-2113.152626 DOI: https://doi.org/10.4103/0970-2113.152626
14. Thapa, K. B., Paudel, A., Dhital, S., Shrestha, A., Ojha, L., & Shrestha, A. (2023). Polycythemia among Patients with Chronic Obstructive Pulmonary Disease Admitted to the Department of Medicine in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA; journal of the Nepal Medical Association, 61 (260), 343–346. https://doi.org/10.31729/jnma.8125 DOI: https://doi.org/10.31729/jnma.8125
15. Kim, J., Kim, Y. T., Leem, A. Y., Jung, J. Y., Kim, Y. S., & Park, Y. (2025). Longitudinal association between hemoglobin and lung function with insights into the incidence of airflow obstruction: an observational study. BMC pulmonary medicine, 25 (1), 50. https://doi.org/10.1186/s12890-025-03505-3 DOI: https://doi.org/10.1186/s12890-025-03505-3
16. Vogelmeier, C. F., Criner, G. J., Martinez, F. J., Anzueto, A., Barnes, P. J., Bourbeau, J., et al. (2017). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: 2017 report. American Journal of Respiratory and Critical Care Medicine, 195 (5), 557–582. DOI: https://doi.org/10.1164/rccm.201701-0218PP
17. Fawzy, A., Putcha, N., Paulin, L. M., et al. (2018). Association of platelet count with morbidity in chronic obstructive pulmonary disease. Respiratory Research, 19, 86.
18. Harrison, M. T., Short, P., Williamson, P. A., et al. (2020). Thrombocytosis and adverse outcomes in chronic obstructive pulmonary disease. Thorax, 75 (7), 610–617.
19. Global Initiative for Chronic Obstructive Lung Disease. (2025). Global strategy for prevention, diagnosis and management of COPD: 2025 report. GOLD.
20. Thomsen, M., Ingebrigtsen, T. S., Marott, J. L., Dahl, M., Lange, P., Vestbo, J., & Nordestgaard, B. G. (2013). Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease. JAMA, 309 (22), 2353–2361. https://doi.org/10.1001/jama.2013.5732 DOI: https://doi.org/10.1001/jama.2013.5732
21. Mannino, D. M., Tal-Singer, R., Lomas, D. A., Vestbo, J., Graham Barr, R., Tetzlaff, K., Lowings, M., Rennard, S. I., Snyder, J., Goldman, M., Martin, U. J., Merrill, D., Martin, A. L., Simeone, J. C., Fahrbach, K., Murphy, B., Leidy, N., & Miller, B. (2015). Plasma Fibrinogen as a Biomarker for Mortality and Hospitalized Exacerbations in People with COPD. Chronic obstructive pulmonary diseases (Miami, Fla.), 2 (1), 23–34. https://doi.org/10.15326/jcopdf.2.1.2014.0138 DOI: https://doi.org/10.15326/jcopdf.2.1.2014.0138
22. Miller, B. E., Tal-Singer, R., Rennard, S. I., Furtwaengler, A., Leidy, N., Lowings, M., Martin, U. J., Martin, T. R., Merrill, D. D., Snyder, J., Walsh, J., & Mannino, D. M. (2016). Plasma Fibrinogen Qualification as a Drug Development Tool in Chronic Obstructive Pulmonary Disease. Perspective of the Chronic Obstructive Pulmonary Disease Biomarker Qualification Consortium. American journal of respiratory and critical care medicine, 193 (6), 607–613. https://doi.org/10.1164/rccm.201509-1722PP DOI: https://doi.org/10.1164/rccm.201509-1722PP
23. Duvoix, A., Dickens, J., Haq, I., Mannino, D., Miller, B., Tal-Singer, R., & Lomas, D.A. (2013). Blood fibrinogen as a biomarker of chronic obstructive pulmonary disease. Thorax, 68 (7), 670–676. https://doi.org/10.1136/thoraxjnl-2012-201871 DOI: https://doi.org/10.1136/thoraxjnl-2012-201871
