title: Systemic cytokines, clinical and physiological changes in patients hospitalized for exacerbation of COPD.
abstract: BACKGROUND
  Systemic inflammation in patients with COPD may worsen during exacerbations, but there is limited information relating levels of systemic inflammatory markers with symptoms and physiologic changes during an exacerbation
  
  
  METHODS
  We measured dyspnea using the visual analog scale, pulmonary function tests, hemograms, and plasma levels for interleukin (IL)-6, IL-8, leukotriene B(4) (LTB4), tumor necrosis factor-alpha, and secretory leukocyte protease inhibitor (SLPI) in 20 patients on admission to a hospital for exacerbation of COPD (ECOPD), 48 h later (interim), and 8 weeks after hospital discharge (recovery).
  
  
  RESULTS
  Dyspnea was present in all patients. Inspiratory capacity improved faster than FEV(1). Compared to recovery, there was a significant increase in the mean (+/- SD) hospital admission plasma levels of IL-6 (6.38 +/- 0.72 to 2.80 +/- 0.79 pg/mL; p = 0.0001), IL-8 (8.18 +/- 0.85 to 3.72 +/- 0.85 pg/mL; p = 0.002), and LTB4 (8,675 +/- 1,652 to 2,534 +/- 1,813 pg/mL; p = 0.003), and the percentages of segmented neutrophils (79 to 69%; p < 0.02) and band forms (7.3 to 1.0%; p < 0.01) in peripheral blood, with no changes in TNF-alpha and SLPI. There were significant correlations between changes in IL-6 (r = 0.61; p = 0.01) and IL-8 (r = 0.56; p = 0.04) with changes in dyspnea and levels of IL-6 (r = -0.51; p = 0.04) and TNF-alpha (r = -0.71; p < 0.02) with changes in FEV(1.)
  
  
  CONCLUSIONS
  Hospitalized patients with ECOPDs experience significant changes in systemic cytokine levels that correlate with symptoms and lung function. An ECOPD represents not only a worsening of airflow obstruction but also increased systemic demand in a host with limited ventilatory reserve.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Pinto-Plata
authors.forename: Guy
authors.initials: G
authors.lastname: Livnat
authors.forename: Mirle
authors.initials: M
authors.lastname: Girish
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Phil
authors.initials: P
authors.lastname: Masdin
authors.forename: Paul
authors.initials: P
authors.lastname: Linacre
authors.forename: Rick
authors.initials: R
authors.lastname: Dew
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kenney
authors.forename: Bartolome R
authors.initials: BR
authors.lastname: Celli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007975:Leukotriene B4 / Q000097:blood; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000503:physiopathology*; D012129:Respiratory Function Tests; D053481:Secretory Leukocyte Peptidase Inhibitor / Q000097:blood; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D053481:Secretory Leukocyte Peptidase Inhibitor; D014409:Tumor Necrosis Factor-alpha; D007975:Leukotriene B4