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Prognostic value of C-reactive protein in chronic obstructive pulmonary disease

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Abstract

To establish whether C-reactive protein (CRP) is an independent predictor of all-cause mortality and hospitalization in chronic obstructive pulmonary disease (COPD), we followed 200 patients with COPD and 201 age- and gender -matched controls for a median time of 4.2 years (range, 0.2–5.1 years). Airflow obstruction was rated moderate if forced expiratory volume in one second (FEV1) was 50–69% of the predicted value, or severe if FEV1 was <50%. The CRP level was categorized as low (≤3 mg/L) or high (>3 mg/L). The hazard of death was estimated by a proportional hazard regression model, using controls with low CRP as the reference category. Fifty subjects died: 41 (21%) among the COPD and 9 (4%) among the controls (p < 0.0001). The hazard of death in moderate COPD was not significantly higher than in the reference category, independently of the CRP level. In severe COPD with a low CRP, the hazard of death is 3.4 times higher than in the reference category (p = 0.008); in severe COPD and a high CRP it is 9.6 times higher (p < 0.0001). The rate of hospitalization in COPD patients with a high CRP is 1.9 times higher than in those with a low CRP [95% confidence interval (CI), 1.2–3.2]. In severe COPD, it is 6.9 times higher than in moderate COPD (95% CI, 3.8–12.7). A high CRP level is a significant amplifier of the risk of death only in severe COPD. The degree of airflow obstruction is a strong independent predictor of COPD-related outcomes.

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Acknowledgments

The authors wish to thank Giosuè Catapano, Gianfranco Mirarchi, and Cristina Carli for excellent clinical and technical assistance. Permission was obtained from those who are acknowledged. This work was supported by the European Union fifth Framework Programme under the contract number QLG1-CT-2001-01012 (COPD GENE SCAN Project). The funding source had no role in the study design, the collection, analysis, or interpretation of data, the writing of the report, or the decision to submit the paper for publication.

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Miniati, M., Monti, S., Bottai, M. et al. Prognostic value of C-reactive protein in chronic obstructive pulmonary disease. Intern Emerg Med 6, 423–430 (2011). https://doi.org/10.1007/s11739-011-0520-z

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