C-reactive protein as a prognostic marker in chronic obstructive pulmonary disease

The roles of C-reactive protein-albumin ratio as a novel prognostic biomarker in heart failure patients: A systematic review

C-Reactive Protein (CRP)-albumin ratio (CAR) is a novel prognostic biomarker that is predicted to be a more reliable indicator than CRP or albumin alone. Therefore, this systematic review aimed to evaluate the role of CAR in predicting poor outcomes of heart failure (HF) patients. We conducted a literature search across ProQuest, PubMed, ScienceDirect, Web of Science, and Scopus. All related studies assessing CAR and reporting mortality outcomes or other adverse outcomes were assessed. A total of five studies with a total of 1821 patients were included in this review. CAR is significantly associated with all-causes in-hospital mortality and out-hospital mortality in patients with acute and chronic heart failure. CAR is associated with higher hospitalization rates, the number of hospitalizations, severe New York Heart Association (NYHA) classification, and the risk of advanced HF. In conclusion, CAR is significantly associated with poor HF outcomes including all-cause mortality (cardiac and non-cardiac death).

Systemic Galectin-3 in Smokers with Chronic Obstructive Pulmonary Disease and Chronic Bronchitis: The Impact of Exacerbations

PURPOSE

The carbohydrate-binding protein Galectin-3 is increased in several inflammatory diseases and has recently been forwarded as a systemic biomarker in chronic obstructive pulmonary disease (COPD). In this longitudinal study, we characterized the level of systemic Galectin-3 using blood from smokers with a history of COPD and chronic bronchitis (COPD-CB), during stable clinical conditions and exacerbations.

PATIENTS AND METHODS

The study population comprised 56 long-term smokers with COPD-CB, 10 long-term smokers without lung disease (LTS) and 10 clinically healthy never-smokers (HNS). Blood samples were analyzed for levels of Galectin-3, leukocyte populations and C-reactive protein (CRP). In addition, sputum samples from the COPD-CB group were analyzed for bacterial growth.

RESULTS

When comparing stable clinical conditions and exacerbations in the COPD-CB group, we found that the level of Galectin-3, just like that of CRP, leukocytes and neutrophils, respectively, was increased during exacerbations. However, this exacerbation-associated increase of Galectin-3 was modest. During stable clinical conditions of COPD-CB, the level of Galectin-3 was not elevated in comparison with HNS or LTS. Nor did this level of Galectin-3 distinguish patients that remained in a clinically stable condition throughout the study to those that developed an exacerbation. In addition, neither during stable clinical conditions nor during exacerbations, did the presence of bacterial growth in sputum alter Galectin-3 levels. In contrast to Galectin-3, the level of CRP, leukocytes and neutrophils, respectively, were increased during clinical stable conditions in the COPD-CB group compared with the other groups and were further enhanced during exacerbations.

CONCLUSION

Systemic Galectin-3 is increased in a reproducible but modest manner during exacerbations in smokers with COPD-CB. During stable clinical conditions, the level of systemic Galectin-3 does not distinguish patients that remain clinically stable from those that develop exacerbations. This makes it less likely that systemic Galectin-3 may become a clinically useful biomarker in the current setting.

Serum Levels of Alpha1-antitrypsin and Their Relationship With COPD in the General Spanish Population

BACKGROUND

Low plasma level of alpha1-antitrypsin (AAT) is an established risk factor for early-onset chronic obstructive lung disease (COPD). However, less attention is given to the levels of AAT in the general population.

METHODS

This is a part of a multicentre, population-based study conducted at 11 sites throughout Spain. Plasma levels of AAT were available for 837 persons with a mean (SD) age of 58.05 (11.3) years: 328-smokers, 272-ex-smokers and 237 non-smokers. Out of 837, 303 (36.2%) had a diagnosis of COPD, 222 (26.5%) had respiratory symptoms but no COPD, and 312 (37.3%) were healthy controls.

RESULTS

In the whole cohort, the mean level of plasma AAT was 1.51 (0.47)g/L. Levels were higher in COPD patients [1.55 (0.45)g/L] and individuals with respiratory symptoms [1.57 (0.47)g/L] than in controls [1.43 (0.47)g/L], p<0.001, a finding which persisted after correction for age and CRP. Plasma AAT levels were negatively associated with FEV1/FVC ratio, after adjustment for age, sex, smoking status, CRP, TNFα, fibrinogen and albumin. The risk for COPD was significantly associated with higher AAT levels in univariate and multivariate models, with odds ratios of 1.8 and 1.5, respectively. In the univariate and multivariate models smoking status, gender, and CRP levels were also associated with COPD probability, demonstrating that they act independently.

CONCLUSION

Increased circulating levels of AAT, similarly to CRP and other markers of systemic inflammation, is an important feature of COPD. Our results highlight a complex interrelationship between levels of AAT and health of respiratory system.

Review of biomarkers to assess the effects of switching from cigarettes to modified risk tobacco products

Context: One approach to reducing the harm caused by cigarette smoking, at both individual and population level, is to develop, assess and commercialize modified risk alternatives that adult smokers can switch to. Studies to demonstrate the exposure and risk reduction potential of such products generally involve the measuring of biomarkers, of both exposure and effect, sampled in various biological matrices.Objective: In this review, we detail the pros and cons for using several biomarkers as indicators of effects of changing from conventional cigarettes to modified risk products.Materials and methods: English language publications between 2008 and 2017 were retrieved from PubMed using the same search criteria for each of the 25 assessed biomarkers. Nine exclusion criteria were applied to exclude non-relevant publications.Results: A total of 8876 articles were retrieved (of which 7476 were excluded according to the exclusion criteria). The literature indicates that not all assessed biomarkers return to baseline levels following smoking cessation during the study periods but that nine had potential for use in medium to long-term studies.Discussion and conclusion: In clinical studies, it is important to choose biomarkers that show the biological effect of cessation within the duration of the study.

Biomarkers of collagen turnover are related to annual change in FEV1 in patients with chronic obstructive pulmonary disease within the ECLIPSE study

Background

Change in forced expiratory volume in one second (FEV₁) is important for defining severity of chronic obstructive pulmonary disease (COPD). Serological neoepitope markers of collagen turnover may predict rate of change in FEV₁.

Methods

One thousand COPD subjects from the observational, multicentre, three-year ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) study (NCT00292552, trial registration in February 2006) were included. Matrix metalloproteinase (MMP)-generated fragments of collagen type I, and type VI (C1M and C6M) were assessed in month six serum samples. A random-coefficient model with both a random intercept and a random slope was used to test the ability of the markers to predict post-dose bronchodilator FEV₁ (PD-FEV₁) change over two years adjusting for sex, age, BMI, smoking, bronchodilator reversibility, prior exacerbations, emphysema and chronic bronchitis status at baseline.

Results

Annual change of PD-FEV₁ was estimated from a linear model for the two-year study period. Serum C1M and C6M were independent predictors of lung function change (p = 0.007/0.005). Smoking, bronchodilator reversibility, plasma hsCRP and emphysema were also significant predictors. The effect estimate between annual change in PD-FEV₁ per one standard deviation (1SD) increase of C1M and C6M was +10.4 mL/yr. and +8.6 mL/yr. C1M, and C6M, had a significant association with baseline FEV₁.

Conclusion

We demonstrated that markers of tissue turnover were significantly associated with lung function change. These markers may function as prognostic biomarkers and possibly as efficacy biomarkers in clinical trials focusing on lung function change in COPD.

Trial registration

NCT00292552, Retrospectively registered, trial registration in February 2006.

Electronic supplementary material

The online version of this article (10.1186/s12890-017-0505-4) contains supplementary material, which is available to authorized users.

A randomised, placebo-controlled trial of anti-interleukin-1 receptor 1 monoclonal antibody MEDI8968 in chronic obstructive pulmonary disease

BACKGROUND

Interleukin-1 receptor 1 (IL-1R1) inhibition is a potential strategy for treating patients with chronic obstructive pulmonary disease (COPD). MEDI8968, a fully human monoclonal antibody, binds selectively to IL-1R1, inhibiting activation by IL-1α and IL-1β. We studied the efficacy and safety/tolerability of MEDI8968 in adults with symptomatic, moderate-to-very severe COPD.

METHODS

This was a phase II, randomised, double-blind, placebo-controlled, multicentre, parallel-group study. Subjects aged 45-75 years and receiving standard maintenance therapy with ≥2 exacerbations in the past year were randomised 1:1 to receive placebo or MEDI8968 300 mg (600 mg intravenous loading dose) subcutaneously every 4 weeks, for 52 weeks. The primary endpoint was the moderate/severe acute exacerbations of COPD (AECOPD) rate (week 56 post-randomisation). Secondary endpoints were severe AECOPD rate and St George's Respiratory Questionnaire-COPD (SGRQ-C) score (week 56 post-randomisation).

RESULTS

Of subjects randomised to placebo (n = 164) and MEDI8968 (n = 160), 79.3% and 75.0%, respectively, completed the study. There were neither statistically significant differences between treatment groups in moderate/severe AECOPD rate ([90% confidence interval]: 0.78 [0.63, 0.96], placebo; 0.71 [0.57, 0.90], MEDI8968), nor in severe AECOPD rate or SGRQ-C scores. Post-hoc analysis of subject subgroups (by baseline neutrophil count or tertiles of circulating neutrophil counts) did not alter the study outcome. The incidence of treatment-emergent adverse events (TEAEs) with placebo and MEDI8968 treatment was similar. The most common TEAE was worsening of COPD.

CONCLUSIONS

In this phase II study, MEDI8968 did not produce statistically significant improvements in AECOPD rate, lung function or quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01448850 , date of registration: 06 October 2011.

C-reactive protein level predicts mortality in COPD: a systematic review and meta-analysis

The prognostic role of baseline C-reactive protein (CRP) in chronic obstructive pulmonary disease (COPD) is controversial. In order to clarify this issue, we performed a systematic review and meta-analysis to assess the predictive effect of baseline CRP level in COPD patients. 15 eligible articles focusing on late mortality in COPD were included in our study. We performed a random-effects meta-analysis, and assessed heterogeneity and publication bias. We pooled hazard ratio (HR) estimates and their 95% confidence intervals on mortality for the comparison between the study-specific highest category of CRP level versus the lowest category. In overall analysis, elevated baseline CRP levels were significantly associated with higher mortality (HR 1.53, 95% CI 1.32-1.77, I²=68.7%, p<0.001). Similar results were observed across subgroups. However, higher mortality risk was reported in studies using a cut-off value of 3 mg·L^-1 (HR 1.61, 95% CI 1.12-2.30) and in those enrolling an Asiatic population (HR 3.51, 95% CI 1.69-7.31). Our analysis indicates that baseline high CRP level is significantly associated with higher late mortality in patients with COPD. Further prospective controlled studies are needed to confirm these data.

Plasma inflammatory biomarkers response to aerobic versus resisted exercise training for chronic obstructive pulmonary disease patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a main risk for morbidity, associated with alterations in systemic inflammation. Recent studies proved that morbidity and mortality of COPD is related to systemic inflammation as it contributes to the pathogenesis of atherosclerosis and cardiovascular disease. However, increase of inflammatory cytokines adversely affects quality of life, alteration in ventilatory and skeletal muscles functions. Moreover, exercise training has many beneficial effects in correction of the adverse effects of COPD.

OBJECTIVE

This study aimed to compare the response of inflammatory cytokines of COPD to aerobic versus resisted exercises.

MATERIALS AND METHODS

One hundred COPD diseased patients participated in this study and were randomly included in two groups; the first group received aerobic exercise, whereas the second group received resisted exercise training for 12 weeks.

RESULTS

The mean values of TNF-α, Il-2, IL-4, IL-6 and CRP were significantly decreased in both groups. Also; there was a significant difference between both groups at the end of the study with more reduction in patients who received aerobic exercise training.

CONCLUSION

Aerobic exercise is more appropriate than resisted exercise training in modulating inflammatory cytokines level in patients with chronic obstructive pulmonary disease.

Platelet function in diabetic and nondiabetic patients with chronic obstructive pulmonary disease: a case control study

BACKGROUND

The effect of association between chronic obstructive pulmonary disease (COPD) and diabetes (DM) on platelet function has not been studied before.

OBJECTIVES

To evaluate the effect of the association between COPD and DM on platelet function and C reactive protein (CRP).

PATIENTS AND METHODS

This case control study was carried out on 110 stable COPD patients who were classified into diabetic and nondiabetic groups. In addition, 40 apparently healthy, age and sex-matched individuals were included in this study as a control group. Chest X-ray, pulmonary function testing and arterial blood gases were done for COPD patients. CRP and complete blood count (CBC) were measured in both patient and control groups.

RESULTS

Mean platelet volume (MPV), platelet distribution width (PDW), platelet crit (PCT) and CRP were significantly higher in COPD patients either nondiabetic or diabetic compared to control group. Moreover, MPV and CRP markers were significantly higher in COPD diabetic patients compared to nondiabetic. There was no significant difference in various laboratory data among different stages of COPD either diabetic or nondiabetic (P > 0.05). In COPD patients, MPV was a significantly positively correlated with CRP and PDW (r = 0.346, P < 0.001; r = 0.510, P < 0.001, respectively) and negatively correlated with PLT count (r = -0.294, P = 0.002).

CONCLUSION

MPV, PDW, PCT and CRP were significantly higher in COPD patients either nondiabetic or diabetic. Platelet function may be modified by the systemic inflammation that associated with COPD. Platelet activation as a prothrombotic sequence of this disease may be used as novel therapeutic target.

Regulatory effect of Bcl-2 in ultraviolet radiation-induced apoptosis of the mouse crystalline lens

The aim of the present study was to analyze the role of Bcl-2 during the process of apoptosis in the mouse crystalline lens. In total, 12 normal mice served as the control group and 12 Bcl-2 knockout (K.O) mice served as the experimental group. The mouse crystalline lens was sampled for the detection of Bcl-2 and caspase-3 expression following exposure to ultraviolet (UV) radiation. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to determine Bcl-2 expression in the groups of normal mice receiving UV radiation or not receiving UV radiation. Samples of the murine crystalline lens were microscopically harvested and analyzed using western blotting. Apoptosis was detected using terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. Furthermore, caspase 3 activity was examined using enzyme-linked immunosorbent assay kits, and RT-qPCR was used to analyze caspase-3 expression levels. The results of the present study demonstrated that there was no statistically significant difference in the level of Bcl-2 gene transcription between the two groups. In addition, UV radiation did not change the macrostructure of the crystalline lens in the group of normal mice or the group of Bcl-2 K.O mice. The results of the TUNEL assay indicated that the normal-UV group exhibited a more significant apoptosis level compared with the Bcl-2 K.O-UV group. Furthermore, the mRNA expression level of caspase-3 in the normal-UV group was significantly higher compared with the normal-nonUV group (P<0.05), while the levels in the Bcl-2 K.O-UV group were significantly higher compared with the Bcl-2 K.O and normal-nonUV groups (P<0.05). In addition, the mRNA expression level of caspase-3 was significantly higher in the normal-UV, as compared with the Bcl-2 K.O-UV group (P<0.05), and the variation trends in caspase-3 activity were consistent. In conclusion, the results of the present study demonstrated that Bcl-2 may have an important role in the promotion of UV-induced apoptosis in the crystalline lens.

Airway bacterial colonization and serum C-reactive protein are associated with chronic obstructive pulmonary disease exacerbation following bronchoscopic lung volume reduction

INTRODUCTION

Stable chronic obstructive pulmonary disease (COPD) patients often have lower airway bacterial colonization (ABC) which may modulate exacerbation frequency. Data regarding the association between ABC and post-procedural COPD exacerbations following bronchoscopic lung volume reduction (BLVR) are scant.

OBJECTIVES

Our aim was to explore the correlation among ABC, serum C-reactive protein (CRP) level and the risk of COPD exacerbation within a month following BLVR.

METHODS

Pre-procedure bronchoalveolar lavage (BAL) quantitative bacterial cultures and serum levels of CRP were evaluated in severe COPD patients (N = 70, mean FEV1  = 34.6%) before BLVR by polymeric lung sealant.

RESULTS

Colonization with potential pathogenic microorganism (PPM) was observed in 40 (57.1%) patients. Out of 28 patients (40%) who had COPD exacerbation within 30 days of BLVR, 23 (82.1%) had PPM in BAL culture compared with only 14 (33.3%) out of 42 patients who had uneventful procedure (P = 0.0027). Serum CRP level was significantly higher in patients with exacerbation compared with those with no exacerbation (mean 47.8 ± 66.0 mg/L vs 13.05 ± 27.7 mg/L, respectively, P = 0.0063). The combination of CRP level above 3.12 mg/L and PPM growth in BAL was observed in 89.2% of patients with exacerbation compared with only 52.3% of patients without exacerbation (P = 0.0031).

CONCLUSIONS

ABC is common in severe COPD patients undergoing BLVR, and along with elevated CRP level both are associated with high risk of immediate post-procedural COPD exacerbation. These patients should be identified, carefully observed and possibly benefit from prophylactic microbiologically directed antibiotic treatment.