Autor/a:
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Gallego, Miguel; Pomares, Xavier; Capilla, Silvia; Marcos Maeso, Ma. Angeles; Suárez, David; Monso, Eduard; Monton, Concepción
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Abstract:
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BACKGROUND: C-reactive protein (CRP) measurement has proven
valuable for detecting exacerbations, but its usefulness in
predicting etiology remains controversial. Likewise, its
potential value as a marker of severity, which is well
established in patients with pneumonia, remains unproven in
chronic obstructive pulmonary disease (COPD) exacerbations.
METHODS: A cohort study of 118 patients with severe COPD and
acute infectious exacerbations were included and followed up
over 1 year. Episodes of exacerbations meeting Anthonisen's
criteria type I-II were evaluated, analyzing the etiology and
inflammatory response as measured by CRP in blood. RESULTS: A
total of 380 episodes were recorded. Full microbiological
analysis was available in 265 samples. Haemophilus influenzae
was the most commonly isolated bacteria and rhinovirus the most
common virus. Median CRP levels from the 265 episodes were
higher in the cases with positive cultures for bacteria (58.30
mg/L, interquartile range [IQR] 21.0-28.2) than in episodes only
positive for viruses (37.3 mg/L, IQR 18.6-79.1) and cases
negative for any microorganism (36.4 mg/L, IQR 10.8-93.7)
(P<0.014). H. influenzae and Streptococcus pneumoniae reached
the highest CRP levels of 74.5 mg/L (IQR 23.9-167.9) and 74.1
mg/L (IQR 42.0-220.7), respectively. In the 380 exacerbations
studied, 227 (~60%) were community-managed, while 153 (~40%)
required hospital admission. In the multivariate analysis to
assess the influence of inflammatory response on exacerbation
severity, baseline hypercapnia (odds ratio [OR]: 2.70, 95%
confidence interval [CI]: 1.46-4.9) and CRP levels >100 mg/L
(OR: 4.23, 95% CI: 2.12-8.44) were independent predictors after
adjustment for baseline characteristics. CONCLUSION: CRP level
was higher in bacterial infections, especially when H.
influenzae and S. pneumoniae were isolated. CRP values >100
mg/L were associated with a fourfold increased risk of hospital
admission. Therefore, CRP blood levels may be a useful biomarker
in the management of exacerbations appearing in patients with
severe disease. |