title: Systemic inflammatory pattern of patients with community-acquired pneumonia with and without COPD.
abstract: BACKGROUND
  Several clinical studies have evaluated the role of COPD in patients with community acquired pneumonia (CAP). We investigated the systemic inflammatory response of patients with CAP (CAP 1 COPD) and patients without associated COPD (CAP only).
  
  
  METHODS
  Clinical, microbiologic, and immunologic data were collected from 367 prospective patients on admission to hospital during a 3-year period. Comparative analyses were performed between patients with CAP 1 COPD (n 5 117) and those with CAP only (n 5 250) and between patients with and without domiciliary use of inhaled corticosteroids (ICSs) and oral corticosteroids.
  
  
  RESULTS
  Detailed characteristics of clinical severity and prognosis (mortality on hospitalization and at 30 and 90 days) were similar between the CAP 1 COPD and CAP-only groups. The readmission rate and the frequency of previous pneumonia were higher in the group of patients with CAP 1 COPD. On day 1 (admission to hospital), patients with CAP 1 COPD had significantly lower serum levels of tumor necrosis factor- a , IL-1, and IL-6 compared with the CAP-only group; levels of the remaining inflammatory biomarkers (C-reactive protein, procalcitonin, IL-8, and IL-10) were similar at days 1 and 3. The exclusion of patients with domiciliary use of ICS and oral corticosteroids confirmed lower levels of TNF- a on day 1 in patients with CAP 1 COPD. Finally, lower levels of IL-6 were found only among those patients with COPD who were currently using ICS.
  
  
  CONCLUSIONS
  Our prospective study demonstrates a different, disease-specific, early inflammatory pattern between patients with CAP with and without associated COPD. These findings are not completely corticosteroid mediated.
authors.affiliation: Department of Pulmonary Rehabilitation, Ospedale Villa Pineta, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Crisafulli
authors.affiliation: Servicio de Neumología, Hospital Universitario y politecnico La Fe, CIBERES, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menéndez
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Huerta
authors.affiliation: Servicio de Neumología, Hospital Universitario y politecnico La Fe, CIBERES, Valencia, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Martinez
authors.affiliation: Servicio de Neumología, Hospital Universitario y politecnico La Fe, CIBERES, Valencia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Montull
authors.affiliation: Department of Pulmonary Rehabilitation, Ospedale Villa Pineta, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Clini
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. Electronic address: ATORRES@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000473:pathology*; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000305:Adrenal Cortex Hormones; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein