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Annual Congress of Malaysian Thoracic Society
Op 6
MMP-9, UPA and SP-A As Sputum Biomarkers For COPD Severity
(SAFE Index) and Exacerbation
Noor Ashikin M R 1 , Roslan H 1 , Azarisman M S 2
1
University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
2
International Islamic University Malaysia, Kuala Lumpur, Malaysia
Introduction
The SAFE index has recently been proposed to evaluate the severity of COPD. However, the correlation
between sputum biomarkers and SAFE index in COPD exacerbation frequency and hospital admission has not
been studied.
Objectives
To evaluate sputum MMP-9, uPA and SP-A as biomarkers for COPD exacerbation and severity as determined
by SAFE index.
Methodology
A prospective observational study was conducted on 72 COPD patients over a period of one year and the
exacerbation rate and severity were recorded. The sputum biomarkers which include matrix metalloproteinase-9
(MMP-9), urokinase plasminogen activator (uPA) and surfactant protein A (SP-A) were measured using ELISA
method at the baseline. The COPD severity was classified according to the SAFE index which comprised of
SGRQ, FEV1%predicted and 6-min walking test.
Results
COPD patients with higher SAFE index score had more frequent and severe exacerbation compared to patient
with lower SAFE index score (p=0.04 and p=0.02 respectively). The sputum SP-A was significantly lower,
0.79 (0.59, 0.99) in COPD patients with severe exacerbation (p= 0.03) while there was no significant difference
in the frequency of exacerbation. However, there were no significant difference in the levels of sputum
MMP-9 and sputum uPA in both the frequency and severity of COPD exacerbation. Sputum MMP-9 had a
weak but significant correlation with 6-minute walking test (p=0.04, r= 0.240) and moderate correlation with
SQRG total score (p=0.01, r= -0.305). There were no significant difference between all the biomarkers and
SAFE stages.
Conclusion
In conclusion, a higher SAFE index score is associated with frequency and severity of COPD exacerbation.
Sputum SP-A is a useful biomarker to predict the severity of COPD exacerbation.
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