title: [Etiology and biomarkers of systemic inflammation in mild to moderate COPD exacerbations].
abstract: BACKGROUND
  The etiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) is heterogeneous and still under discussion. Inflammation increases during exacerbation of COPD. The identification of inflammatory changes will increase our knowledge and potentially guide therapy.
  
  
  OBJECTIVE
  To identify which inflammatory parameters increase during COPD exacerbations compared to stable disease, and to compare bacterial and viral exacerbations.
  
  
  METHODS
  In 85 COPD patients (45 males, mean age 68 ± 8 years, FEV1 46 ± 17% of predicted) sputum, nasopharyngeal swabs and blood samples were collected to identify the causative organism, during a mild to moderate exacerbation. Serum ultrasensitive C reactive protein (CRP), fibrinogen and interleukin 6 (IL 6), neutrophil and leukocyte counts were measured in stable conditions, during a COPD exacerbation, 15 and 30 days post exacerbation.
  
  
  RESULTS
  A total of 120 mild to moderate COPD exacerbations were included. In 74 (61.7%), a microbial etiology could be identified, most commonly Mycoplasma pneumoniae (15.8%), Rhinovirus (15%), Haemophilus influenzae (14.2%), Chlamydia pneumoniae (11.7%), Streptococcus pneumoniae (5.8%) and Gram negative bacilli (5.8%). Serum CRP, fibrinogen and IL 6, and neutrophil and leukocyte counts significantly increased during exacerbation and recovered at 30 days post exacerbation. Compared to viral exacerbations, bacterial aggravations were associated with a systemic inflammation of higher magnitude.
  
  
  CONCLUSIONS
  Biomarkers of systemic inflammation increase during mild to moderate COPD exacerbations. The increase in systemic inflammation seems to be limited to exacerbations caused by bacterial infections.
authors.affiliation: Servicio de Medicina Interna, Hospital San Juan de Dios, Santiago, Chile.
authors.forename: P Fernando
authors.initials: PF
authors.lastname: Saldías
authors.forename: P Orlando
authors.initials: PO
authors.lastname: Díaz
authors.forename: D Jorge
authors.initials: DJ
authors.lastname: Dreyse
authors.forename: B Aldo
authors.initials: BA
authors.lastname: Gaggero
authors.forename: A Christian
authors.initials: AC
authors.lastname: Sandoval
authors.forename: B Carmen
authors.initials: BC
authors.lastname: Lisboa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000382:microbiology / Q000821:virology; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology*
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D015850:Interleukin-6; D005340:Fibrinogen; D002097:C-Reactive Protein