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Background  Functional deficiency of mannose-binding lectin (MBL) may contribute to the pathogenesis of chronic obstructive pulmonary disease. We hypothesized that specific MBL2 gene polymorphisms and circulating MBL protein levels are associated with clinically relevant outcomes in the Predicting Outcome using systemic Markers In Severe Exacerbations of COPD PROMISE-COPD cohort.    Methods  We followed 277 patients with stable COPD GOLD stage II-IV COPD over a median period of 733 days (IQR 641–767) taking survival as the primary outcome parameter. Patients were dichotomized as frequent (≥2 AECOPD/year) or infrequent exacerbators. Serum MBL levels and single nucleotide polymorphisms of the MBL2 gene were assessed at baseline.    Results  The  MBL2-HYPD  haplotype was significantly more prevalent in frequent exacerbators (OR: 3.33; 95 % CI, 1.24–7.14,  p  = 0.01). The median serum MBL concentration was similar in frequent (607 ng/ml, [IQR; 363.0–896.0 ng/ml]) and infrequent exacerbators (615 ng/ml, [IQR; 371.0–942.0 ng/ml]). Serum MBL was not associated with lung function characteristics or bacterial colonization in sputum. However, high serum MBL at stable state was associated with better survival compared to low MBL ( p  = 0.046, log rank test).    Conclusions  In COPD, the  HYPD  haplotype of  MBL2  gene is associated with frequent exacerbations and high serum MBL is linked to increased survival.  The PROMISE-COPD study was registered at  www.controlled-trials.com  under the identifier  ISRCTN99586989 .    Electronic supplementary material  The online version of this article (doi:10.1186/s12931-015-0306-3) contains supplementary material, which is available to authorized users.

Mannose-binding lectin protein and its association to clinical outcomes in COPD: a longitudinal study