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Background: As a biomarker of alveolar-capillary basement membrane injury, Krebs von den Lungen-6 (KL-6) is involved in the occurrence and development of pulmonary diseases. However, the role of the KL-6 in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has yet to be elucidated. This prospective study was designed to clarify the associations of the serum KL-6 with the severity and prognosis in patients with AECOPD. Methods: This study enrolled 199 eligible AECOPD patients. Demographic data and clinical characteristics were recorded. Follow-up was tracked to evaluate acute exacerbation and death. The serum KL-6 concentration was measured via an enzyme-linked immunosorbent assay. Results: Serum KL-6 level at admission was higher in AECOPD patients than in control subjects. The serum KL-6 concentration gradually elevated with increasing severity of AECOPD. Pearson and Spearman analyses revealed that the serum KL-6 concentration was positively correlated with the severity score, monocyte count and concentrations of C-reactive protein, interleukin-6, uric acid, and lactate dehydrogenase in AECOPD patients during hospitalization. A statistical analysis of long-term follow-up data showed that elevated KL-6 level at admission was associated with longer hospital stays, an increased risk of future frequent acute exacerbations, and increased severity of exacerbation in COPD patients. Conclusion: Serum KL-6 level at admission is positively correlated with increased disease severity, prolonged hospital stay and increased risk of future acute exacerbations in COPD patients. There are positive dose–response associations of elevated serum KL-6 with severity and poor prognosis in COPD patients. The serum KL-6 concentration could be a novel diagnostic and prognostic biomarker in AECOPD patients. [ABSTRACT FROM AUTHOR]

Background Systemic corticosteroids ( SCS) have been shown to improve the outcome of acute exacerbation of chronic obstructive pulmonary disease ( AECOPD). However, the optimal dose remains controversial. Objectives We performed a meta-analysis to evaluate whether high-dose SCS is better. Methods We searched PubMed, EMBASE, CPCI- S and CENTRAL databases, and references of reviews or meta-analyses to identify randomized controlled trials using SCS in AECOPD. We performed a routine meta-analysis to evaluate the effects of SCS on treatment failure rate and forced expiratory volume in 1 s ( FEV1) improvement compared with placebo in AECOPD. Subgroup analysis was performed by dividing the studies into a high-dose group [initial dose ≥80 mg prednisone equivalent ( PE)/day] and a low-dose group (initial dose 30-80 mg PE/day) in all patients and in only inpatients. Meta-regression was performed using initial dose as an independent factor. We classified the suspected adverse effects into several groups and combined them separately. Results Our search yielded 12 studies involving 1172 patients. SCS use was associated with a significant reduction in the treatment failure rate [risk ratio 0.58; 95% confidence interval ( CI): 0.46-0.73] and improvement in ▵ FEV1 (0.11 L; 95% CI: 0.08-0.14 L). The high-dose regimen did not show superiority to the low-dose regimen. No obvious correlation was found between the SCS effect and the initial dose. SCS led to an obvious increase in hyperglycemia risk. However, the high-dose group did not show obviously higher risk of adverse effects. Conclusion SCS can reduce treatment failure rate and improve lung function in AECOPD. The low-dose regimen (initial dose 30-80 mg/day PE) is proper for treating AECOPD. [ABSTRACT FROM AUTHOR]