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C- Reactive Protein levels and survival in patients with moderate to very severe COPD

Juan P de Torres, MD^*; Victor Pinto-Plata, MD; Ciro Casanova, MD; Hanna Mullerova, PhD; Elizabeth Córdoba-Lanús, PhD^*; Mercedes Muros de Fuentes, MD^||; Armando Aguirre-Jaime, PhD^* and Bartolome R Celli, MD

^*Respiratory Research Unit Pulmonary and ^||Biochemical Analysis Departments, Hospital Ntra Sra de Candelaria, Tenerife, Spain Pulmonary and Critical Care Department, Caritas St Elizabeth's Medical Center, Boston, USA GlaxoSmithKline, Worldwide Epidemiology Department, London, UK

jupa65{at}hotmail.com

Abstract

Background: Serum levels of CRP are increased in patients with COPD and correlate modestly with variables predictive of outcomes. In epidemiological studies, CRP level is associated with all cause mortality in patients with mild to moderate disease.

Objective: To determine if CRP levels are associated with survival in patients with moderate to very severe COPD in comparison with other well-known prognostic parameters of the disease.

Methods: In 218 stable patients with COPD we measured baseline serum CRP level, BODE index and its components, arterial oxygenation (PaO₂), inspiratory to total lung capacity ratio (IC/TLC) and Charlson co-morbidity score. We followed the patients over time and evaluated the strength of the association between the variables and all cause mortality.

Results: During the follow-up time (median 36, 25-75^th percentiles: 24-50 months), 54 patients (25%) died. CRP levels were similar between survivors and deceased (3.8 mg/L, 95% CI. 1.9-8.1 vs. 4.5 mg/L, 95% CI, 2.1-11.5, p=0.22) and was not significantly associated with survival.

Conclusions: In this population of patients with clinically moderate to very severe COPD, the level of CRP level was not associated with survival compared with other prognostic clinical tools such as the BODE index, MMRC, 6MWD, FEV₁%, IC/TLC<0.25 and PaO₂. Other long-term studies of well characterized patients with COPD could help determine the exact role of CRP levels as a biomarker in patients with clinical COPD.

Key Words: C-Reactive Protein • COPD • Survival