Hyaluronic Acid As A Novel Systemic Biomarker to Predict Progression and Severity in Chronic Obstructive Pulmonary Disease

Background: Hyaluronic acid (HA) is a major component of the lung with a key role in airway remodeling in chronic obstructive pulmonary disease (COPD). During exacerbations of COPD (AECOPD) HA is elevated in the BAL as compared to the stable state of the disease. Aims and objectives: The aim of our study was to investigate if serum HA can be used as a biomarker to predict the rate and severity of exacerbations in patients with COPD and to anticipate the clinical outcome following exacerbations. Methods: This is a prospective, observational, multicenter study including 506 patients with COPD, GOLD stages II-IV, >10 PY seeking care in pulmonary tertiary hospitals in 8 European countries and included in the PROMISE cohort. The primary outcome of the study was exacerbation and/or death. Median observation time was 24 months. Serum levels of HA were measured by ELISA in patients with COPD at a stable state in the derivation cohort (n=100) and at stable state, exacerbation and 4 weeks after exacerbation in the confirmation cohort (n=506). Results: Serum levels of HA were positively correlated with FEV1% pred (p=0.002) and FEV/FVC (p=0.025). Furthermore, HA was associated significantly (p Conclusions: Our results indicate that HA may be used as systemic biomarker to predict COPD progression and severity.