title: Pneumonic and nonpneumonic exacerbations of COPD: inflammatory response and clinical characteristics.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) is a frequent event in patients with COPD, although it is not currently considered an acute exacerbation of COPD (AECOPD). To our knowledge, no studies have compared the inflammatory response of patients with COPD who develop CAP or AECOPD. The aim of our study was to compare clinical and evolutive manifestations and biologic signaling of AECOPD and CAP + COPD.
  
  
  METHODS
  Prospective data were collected from 249 consecutively hospitalized patients with COPD. Comparative analyses were performed in patients with AECOPD (n = 133) and patients with CAP + COPD (n = 116). Measures of clinical characteristics, blood biomarkers, and evolution were recorded on admission, after 3 and 30 days, and in a follow-up period of 30 days, 90 days, and 1 year.
  
  
  RESULTS
  Patients with CAP + COPD had higher FEV1 compared with patients with COPD without pneumonia. In-hospital and long-term outcomes (1 year) were similar for both populations. However, patients with AECOPD had more readmissions, and patients with CAP had more prior episodes of pneumonia. At day 1 and day 3, patients with CAP + COPD had significantly (P &lt; .001) higher serum levels of C-reactive protein (CRP), procalcitonin, tumor necrosis factor-α, and IL-6. Repetition of the analyses after stratifying patients based on severity of disease, current inhaled pharmacotherapy, and noninfectious AECOPD cause confirmed higher levels of the same biomarkers in patients with CAP + COPD. Chills, pleuritic pain, sputum purulence, and CRP levels at day 1 were independent clinical predictors of CAP + COPD.
  
  
  CONCLUSIONS
  Our study confirms that two different clinical and inflammatory profiles exist in hospitalized patients with COPD in response to CAP (stronger response) and AECOPD, although with similar short-term and long-term outcomes.
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Huerta
authors.affiliation: Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Crisafulli
authors.affiliation: Pneumology Department, Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menéndez
authors.affiliation: Pneumology Department, Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Martínez
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain.
authors.forename: Néstor
authors.initials: N
authors.lastname: Soler
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Guerrero
authors.affiliation: Pneumology Department, Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Montull
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain. Electronic address: atorres@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology; D008297:Male; D011014:Pneumonia / Q000150:complications*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis*