Value of C-reactive protein measurements in exacerbations of chronic obstructive pulmonary disease

Abstract

C-reactive protein (CRP) has been shown to be a useful and sensitive indicator of pyogenic infections in many clinical situations, including acute pneumonia and infective pulmonary exacerbations in cystic fibrosis patients. Exacerbations of COPD are often, but not always, associated with demonstrable infection. The value of CRP measurement in this situation has not been assessed. We have evaluated CRP measurement in 50 patients [age 71 +/- 8 (SD) years] who were admitted to hospital with clinical evidence of exacerbation [PaO2 = 7.3 +/- 1.3 (SD) kPa, baseline FEV1 = 0.8 +/- 0.4 (SD) l]. These patients all had serial measurement of CRP [polarizing immunofluorescence (Abbot, TDx)], peripheral white cell count (WCC), body temperature, peak expiratory flow rate, Karnofsky performance status and chest X-ray, in addition to serial sputum bacteriological analysis carried out in a specialized laboratory. CRP was elevated (> 10 mg l-1) in all patients (n = 29) with proven infection [103 +/- 98 (SD) mg l-1]. Levels were markedly elevated in patients infected with Streptococcus pneumoniae (mean 156 mg l-1); there was also a rapid fall in the CRP with therapy. WCC fell with therapy, giving a correlation with CRP level (r = 0.44, P < 0.01). Since CRP elevation was observed in patients having exacerbation with proven infections and also in those where infection was not proven, it is possible that, while it is a marker for COPD exacerbation, it is not necessarily a marker of bacterial infection per se. However, it is evident from our study that it is of value in the assessment of exacerbations of COPD, where routine bacterial culture of sputum is often unreliable, and thus the measurement of serum CRP may provide an additional objective indicator of infection.

Correlation of C-Reactive Protein and Copd Severity

“…These results are in favor of the proven fact that COPD is a systemic inflammatory disease which primarily affects the lungs [17][18][19][20] . Similar results were obtained in the studies which suggest that the reduced lung function in COPD is associated with increased levels of systemic inflammatory markers [20][21][22][23][24] .…”

Prevalence and Prognosis of Chronic Obstructive Pulmonary Disease Among 8167 Middle Eastern Patients With Acute Coronary Syndrome

“…10 -16 C-reactive protein (CRP), a known marker of systemic inflammation, has been shown to be elevated in patients with both stable COPD and during exacerbation. [17][18][19][20][21] Because elevations in CRP have also been linked to CAD, 22 it appears as though the pathogenesis of both COPD and CAD may stem from enhanced systemic inflammation. Interestingly, although the mortality rate from cardiovascular diseases is decreasing in the developed world, the mortality rate from COPD is in fact increasing, and COPD is the fourth leading cause of death in the United States.…”

Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

“…A systemic inflammatory response during an AE-COPD has been noted with increases in plasma fibrinogen, IL-6, C-reactive protein (CRP), and endothelin-1, all reported to increase during exacerbations (31)(32)(33)(34). Interestingly, one group has confirmed that the degree of systemic inflammation, shown by rising serum IL-6 and CRP levels, correlated with sputum and nasal inflammation (35).…”