In patients with stable chronic obstructive pulmonary disease (COPD), elevated levels of a combination of three inflammatory biomarkers may predict an increased risk of having serious exacerbations. According to a study published in the June 12 issue of the Journal of the American Medical Association, simultaneously elevated levels of C-reactive protein (CRP), fibrinogen, and leukocyte counts were tied to an increased risk of having exacerbations, even in those with milder COPD and in those without a history of previous exacerbations. Currently, the best predictor of exacerbations in all grades of COPD is a previous exacerbation; however this method has a low positive predictive value. Previous studies have found that elevated levels of inflammatory biomarkers like CRP (cutoff 3mg/L), fibrinogen (cutoff 14 μmol/L), and leukocytes (9 Χ109/L) during stable COPD are associated with poor outcomes and in this study the researchers sought to determine if there was also an association with exacerbations. The researchers examined a subcohort of 6,574 patients with COPD participating in two general population studies—the Copenhagen City Heart Study (2001-2003) and the Copenhagen General Population Study (2003-2008). The subset of COPD patients did not have self-reported asthma. Baseline biomarker levels were measured in participants when they were not […]
In patients with stable chronic obstructive pulmonary disease (COPD), elevated levels of a combination of three inflammatory biomarkers may predict an increased risk of having serious exacerbations. According to a study published in the June 12 issue of the Journal of the American Medical Association, simultaneously elevated levels of C-reactive protein (CRP), fibrinogen, and leukocyte counts were tied to an increased risk of having exacerbations, even in those with milder COPD and in those without a history of previous exacerbations.
Currently, the best predictor of exacerbations in all grades of COPD is a previous exacerbation; however this method has a low positive predictive value. Previous studies have found that elevated levels of inflammatory biomarkers like CRP (cutoff 3mg/L), fibrinogen (cutoff 14 μmol/L), and leukocytes (9 Χ109/L) during stable COPD are associated with poor outcomes and in this study the researchers sought to determine if there was also an association with exacerbations.
The researchers examined a subcohort of 6,574 patients with COPD participating in two general population studies—the Copenhagen City Heart Study (2001-2003) and the Copenhagen General Population Study (2003-2008). The subset of COPD patients did not have self-reported asthma. Baseline biomarker levels were measured in participants when they were not experiencing symptoms of exacerbations. Exacerbations were defined as short-course treatment with oral corticosteroids alone or in combination with an antibiotic or as a hospital admission due to COPD.
Over a median of four years of follow-up there were 3,083 exacerbations recorded (mean, 0.5 per participant) with 931 individuals having at least one exacerbation and 423 having frequent exacerbations (two or more less than one year apart). Risk of having at least one exacerbation and risk of having frequent exacerbations increased stepwise with the number of high inflammatory biomarkers. In the first year of follow-up, when adjusting for other variables, the odds for having frequent exacerbations increased significantly from 17 events per 1,000 person-years for individuals with one high biomarker to 32 events per 1,000 person-years for individuals with two high biomarkers to 81 events per 1,000 person-years for individuals with three high biomarkers compared with individuals who had no elevated biomarkers (nine events per 1,000 person-years).
“Our study provides novel information that may lead to a simpler assessment using measurements of inflammatory biomarkers in individuals with stable COPD to further stratify preventive therapies based on absolute risk of frequent exacerbations,” write the authors, led by Mette Thomsen, M.D., from Copenhagen University Hospital in Denmark.
