title: Prognostic value of C-reactive protein, leukocytes, and vitamin d in severe chronic obstructive pulmonary disease.
abstract: Inflammatory biomarkers predict mortality and hospitalisation in chronic obstructive pulmonary disease (COPD). Yet, it remains uncertain if biomarkers in addition to reflecting disease severity add new prognostic information on severe COPD. We investigated if leukocytes, C-reactive protein (CRP), and vitamin D were independent predictors of mortality and hospitalisation after adjusting for disease severity with an integrative index, the i-BODE index. In total, 423 patients participating in a pulmonary rehabilitation programme, with a mean value of FEV1 of 38% of predicted, were included. Mean followup was 45 months. During the follow-up period, 149 deaths (35%) were observed and 330 patients (78.0%) had at least one acute hospitalisation; 244 patients (57.7%) had at least one hospitalisation due to an exacerbation of COPD. In the analysis (Cox proportional hazards model) fully adjusted for age, sex, and i-BODE index, the hazard ratio for 1 mg/L increase in CRP was 1.02 (P=0.003) and for 1×10(9)/L increase in leukocytes was 1.43 (P=0.03). Only leukocyte count was significantly associated with hospitalisation. Vitamin D was neither associated with mortality nor hospitalisation. Leukocytes and CRP add little information on prognosis and vitamin D does not seem to be a useful biomarker in severe COPD in a clinical setting.
authors.affiliation: Section of Respiratory Medicine, Hvidovre University Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
authors.forename: Mia
authors.identifier: 0000-0002-0960-4260
authors.initials: M
authors.lastname: Moberg
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark ; Respiratory and Allergy Research Group, Manchester Academic Health Science Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
authors.affiliation: Section of Respiratory Medicine, Hvidovre University Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
authors.forename: Gerd
authors.initials: G
authors.lastname: Martinez
authors.affiliation: Section of Respiratory Medicine, Hvidovre University Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark ; Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
authors.affiliation: Section of Respiratory Medicine, Hvidovre University Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ringbaek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D014807:Vitamin D / Q000097:blood*
chemical_list: D015415:Biomarkers; D014807:Vitamin D; D002097:C-Reactive Protein