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Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease

Hurst, JR; Donaldson, GC; Perera, WR; Wilkinson, TMA; Bilello, JA; Hagan, GW; Vessey, RS; (2006) Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease. AM J RESP CRIT CARE , 174 (8) 867 - 874. 10.1164/rccm.200604-506OC.

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Abstract

Impact. This study explores the use of measuring plasma biomarkers at exacerbation of chronic obstructive pulmonary disease (COPD), providing insight into the underlying pathogenesis of these important events.Rationale: The use of measuring C-reactive protein (CIRP) to confirm exacerbation, or to assess exacerbation severity, in COPD is unclear. Furthermore, it is not known whether there may be more useful systemic biomarkers.Objective: To assess the use of plasma biomarkers in confirming exacerbation and predicting exacerbation severity.Methods: We assessed 36 biomarkers in 90 paired baseline and exacerbation plasma samples from 90 patients with COPD. The diagnosis of exacerbation fulfilled both health care use and symptom-based criteria. Biomarker concentrations were related to clinical indices of exacerbation severity. Interrelationships between biomarkers were examined to gain information on mechanisms of systemic inflammation at exacerbation of COPD.Measurements and Main Results: To confirm the diagnosis of exacerbation, the most selective biomarker was CRIP. However, this was neither sufficiently sensitive nor specific alone (area under the receiver operating characteristic curve [AUC], 0.73; 95% confidence interval, 0.66-0.80). The combination of CRIP with any one increased major exacerbation symptom recorded by the patient on that day (dyspnea, sputum volume, or sputum purulence) significantly increased the AUC to 0.88 (95% confidence interval, 0.82-0.93; p < 0.0001). There were no significant relationships between biomarker concentrations and clinical indices of exacerbation severity. Interrelationships between biomarkers suggest that the acute-phase response is related, separately, to monocytic and lymphocytic-neutrophilic pathways.Conclusions: Plasma CRP concentration, in the presence of a major exacerbation symptom, is useful in the confirmation of COPD exacerbation. Systemic biomarkers were not helpful in predicting exacerbation severity. The acute-phase response at exacerbation was most strongly related to indices of monocyte function.

Type: Article
Title: Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease
DOI: 10.1164/rccm.200604-506OC
Keywords: chronic obstructive pulmonary disease, exacerbation, inflammation, C-REACTIVE PROTEIN, SPUTUM INFLAMMATORY MARKERS, CHRONIC-BRONCHITIS, SYSTEMIC INFLAMMATION, LUNG-FUNCTION, LOWER AIRWAY, COPD EXACERBATIONS, COMPLEMENT, BACTERIAL, DECLINE
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Internal Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
URI: http://discovery.ucl.ac.uk/id/eprint/8090
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