C-reactive Protein As a Predictor of Prognosis in Chronic Obstructive Pulmonary Disease.
Dahl, Morten; Vestbo, Jorgen; Lange, Peter; Bojesen, Stig E.; Tybjaerg-Hansen, Anne; Nordestgaard, Borge G.
[Miscellaneous]
American Journal of Respiratory & Critical Care Medicine.
175(3):250-255, February 1, 2007.
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: Rationale: Patients with chronic obstructive pulmonary disease (COPD) have an ongoing systemic inflammation, which can be assessed by measuring serum C-reactive protein (CRP).
Objective: To determine whether increased serum CRP in individuals with airway obstruction predicts future hospitalization and death from COPD.
Methods: We performed a cohort study with a median of 8-yr follow-up of 1,302 individuals with airway obstruction selected from the ongoing Copenhagen City Heart Study.
Measurements and Main Results: We measured serum CRP at baseline, and recorded COPD admissions and deaths as outcomes. During follow-up, 185 (14%) individuals were hospitalized due to COPD and 83 (6%) died of COPD. Incidences of COPD hospitalization and COPD death were increased in individuals with baseline CRP > 3 mg/L versus <= 3 mg/L (log rank: p < 0.001). After adjusting for sex, age, FEV1% predicted, tobacco consumption, and ischemic heart disease, the hazard ratios for hospitalization and death due to COPD were increased at 1.4 (95% confidence interval, 1.0-2.0) and 2.2 (1.2-3.9) in individuals with baseline CRP > 3 mg/L versus <= 3 mg/L. After close matching for FEV1% predicted and adjusting for potential confounders, baseline CRP was, on average, increased by 1.2 mg/L (analysis of variance: p = 0.002) and 4.1 mg/L (p = 0.001) in those who were subsequently hospitalized or died of COPD, respectively. The absolute 10-yr risks for COPD hospitalization and death in individuals with CRP above 3 mg/L were 54 and 57%, respectively, among those older than 70 yr with a tobacco consumption above 15 g/d and an FEV1% predicted of less than 50.
Conclusions: CRP is a strong and independent predictor of future COPD outcomes in individuals with airway obstruction.
(C) 2007 American Thoracic Society