Prognosis of glucocorticoid response in patients with acute exacerbation of COPD using macrophage migration inhibitory factor

Background: The efficacy of corticosteroids significantly varies between patients with acute exacerbation of COPD (AECOPD), therefore prediction of steroid response is necessary for the prescription of adequate treatment. Aim: The aim of the present study was to establish whether cytokines levels and percentages of lymphocytes subpopulations in peripheral blood of patients with AECOPD could predict the response of alveolar macrophages to glucocorticoids. Methods: A total of 45 patients (39 men and 6 women) entered the study. All patients were hospitalized due to AECOPD and underwent bronchoscopy. On the basis of interleukin 8 (IL-8) secretion by alveolar macrophages isolated from bronchoalveolar lavage fluid and exposed to lipopolysaccharide and six different concentrations of dexamethasone (0.01 – 1000 nM) all patients were devided into steroid sensitive (SS, n=27) and steroid resistant (SR, n=18). Results: There was a greater improvement in quality of life assessed by CAT score in SS compared with SR after 15 days of systemic steroid therapy. Plasma concentration of macrophage migration inhibitory factor (MIF) was higher in SR compared with SS. There were no significant differences in the levels of IL-4, IL-6, IL-8, IL-17A, tumor necrosis factor a, granulocyte chemotactic protein 2 and the percentages of CD3+, CD3+CD4+, CD4+CD25+CD127-, CD3+CD8+, CD3-CD56+, CD3+CD56+, CD19+, CD14+ cells between SR and SS patients. At a cut-off value of 2.24 ng/mL the corresponding sensitivity, specificity and area under ROC curve of MIF as a predictor of steroid resistance were 72.2%, 70.4%, and 0.740. Conclusion: MIF can be used for the prognosis of steroid response.