EARLY BIOMARKERS OF PULMONARY HYPERTENSION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Abstract

Pulmonary hypertension (PH) is a serious and often underdiagnosed complication in patients with chronic obstructive pulmonary disease (COPD), contributing significantly to morbidity, mortality, and diminished quality of life. Early detection of PH remains a major clinical challenge due to the delayed onset of recognizable symptoms and limitations in existing diagnostic modalities. This multi-center cross-sectional study aimed to identify early circulating biomarkers that could signal the onset of pulmonary hypertension in COPD patients. A total of 360 participants—including 240 COPD patients with and without PH, and 120 healthy controls—were evaluated for a wide range of endothelial, inflammatory, oxidative stress, and cardiac remodeling biomarkers. Results demonstrated significantly elevated levels of NT-proBNP, endothelin-1, IL-6, malondialdehyde (MDA), and Galectin-3 in COPD patients with PH compared to both COPD-only and control groups (p < 0.001). NT-proBNP showed the highest predictive ability for early PH with an AUC of 0.89, while other biomarkers such as IL-6 and endothelin-1 also displayed strong diagnostic potential. Low nitric oxide and less effective overall antioxidants helped confirm that problems in the endothelium and imbalance in oxidative stress exist. Furthermore, we noted variations in certain proteins involving the alveoli, suggesting that this part of the lung was already involved at the beginning. A multi-biomarker strategy is shown by ROC curve analysis to result in better accuracy for identifying early PH in COPD. Because of these findings, it is clear that using molecular biomarkers with routine screening could help doctors identify COPD-associated pulmonary hypertension sooner and improve its treatment.