Is increased gastro-intestinal permeability related to exacerbation in patients with chronic obstructive pulmonary disease?

Background: Increased gastro-intestinal (GI) permeability has been previously observed in patients with chronic obstructive pulmonary disease (COPD) but its relation with systemic inflammation and/or increased risk of exacerbations is unknown. This study aimed to compare GI permeability between COPD patients and non-COPD controls and to investigate whether its association with is increased in patients with frequent exacerbations compared to those without and to assess whether GI permeability predicts exacerbations during follow-up. Methods: Plasma concentrations of Intestinal Fatty Acid-Binding Protein (I-FABP) were determined in participants of the ICE-AGE study, an observational study with a longitudinal follow-up of 2 years. Results: Two-hundred-and-seven patients with COPD (58% males, age: 62.2±7.0 y, FEV1: 49.4±15.6%) and 200 non-COPD controls (45% males, age: 60.8±6.5 y) were included. I-FABP levels were significant higher in COPD compared to controls (Median(QR) 1115.3(829.3-1729.7)pg/ml vs 950.2(707.2-1482.2)pg/ml p=0.004). I-FABP levels were not related to previous exacerbation history. COPD patients with frequent exacerbations or hospital admissions for ECOPD during follow-up had comparable I-FABP levels to those without these events. I-FABP was related to plasma IL-8 in COPD (Spearman r=0.2082; p Conclusion: I-FABP is increased in COPD compared to non-COPD, reflecting GI disintegrity. However, association with risk of exacerbations was not observed.