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Published ahead of print on October 19, 2006, doi:10.1164/rccm.200605-713OC

Am. J. Respir. Crit. Care Med., Volume 175, Number 3, February 2007, 250-255

A more recent version of this article appeared on February 1, 2007
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Submitted on May 29, 2006
Accepted on October 19, 2006

C-reactive Protein as a Predictor of Prognosis in COPD

Morten Dahl1, Jorgen Vestbo2, Peter Lange3, Stig E Bojesen1, Anne Tybjaerg-Hansen4, and Borge G Nordestgaard5*

1 Department of Clinical Biochemistry, Herlev University Hospital, Herlev, Denmark, 2 Department of Cardiology and Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark; North West Lung Centre, Wythenshawe Hospital, Manchester, United Kingdom; Bispebjerg University Hospital, Copenhagen City Heart Study, Conpenhagen, Denmark, 3 Department of Cardiology and Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark; Bispebjerg University Hospital, Copenhagen City Heart Study, Conpenhagen, Denmark, 4 Department of Clinical Biochemistry, Rigshopitalet, Copenhagen University Hospital, United Kingdom; Bispebjerg University Hospital, Copenhagen City Heart Study, Conpenhagen, Denmark, 5 Department of Clinical Biochemistry, Herlev University Hospital, Herlev, Denmark; Bispebjerg University Hospital, Copenhagen City Heart Study, Conpenhagen, Denmark

* To whom correspondence should be addressed. E-mail: brno{at}herlevhosp.kbhamt.dk.

Rationale: Patients with 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 predict future hospitalization and death from COPD. Methods: We performed a cohort study with a median of 8-years 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 from COPD. Incidences of COPD hospitalization and COPD death were increased in individuals with baseline CRP >3mg/L vs. ≤3mg/L (Log-rank:Ps<0.001). After adjusting for gender, 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% CI: 1.0-2.0) and 2.2 (1.2-3.9) in individuals with baseline CRP >3mg/L vs. ≤3mg/L. After close matching for FEV1% predicted and adjusting for potential confounders, baseline CRP was on average increased by 1.2 mg/L (ANOVA: P=0.002) and 4.1 mg/L(P=0.001) in those who were subsequently hospitalized or died from COPD, respectively. The absolute 10-year risks for COPD hospitalization and death in individuals with CRP above 3mg/L amounted to 54% and 57% among those older than 70 years, with a tobacco consumption above 15g/day and FEV1% predicted 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




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