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C-reactive Protein As a Predictor of Prognosis in Chronic Obstructive Pulmonary Disease

Department of Clinical Biochemistry, Herlev University Hospital, Herlev; Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen; Department of Cardiology and Respiratory Medicine, Hvidovre University Hospital, Hvidovre; Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark; and North West Lung Centre, Wythenshawe Hospital, Manchester, United Kingdom

Correspondence and requests for reprints should be addressed to Børge G. Nordestgaard, M.D., D.M.Sc., Professor, Chief Physician, Department of Clinical Biochemistry, 54M1, Herlev University Hospital, Herlev Ringvej 75, Herlev DK-2730, Denmark. E-mail: brno{at}herlevhosp.kbhamt.dk

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.

Key Words: cohort study • lung diseases, obstructive • airway obstruction • inflammation • biological markers

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject C-reactive protein (CRP) has been shown to be a marker of inflammation in atherosclerosis and levels of CRP correlate with the degree of pulmonary inflammation in stable COPD. What This Study Adds to the Field Serum C-reactive protein is a strong long-term predictor of clinical COPD outcomes in individuals with airway obstruction.

 

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