Adenovirus-specific IgG maturation as a surrogate marker in acute exacerbations of COPD.
BACKGROUND
B cells in airways and lung parenchyma may be involved in COPD evolution; however, whether their pathogenic role is beneficial or harmful remains controversial. The objective of this study was to investigate the maturation of adenovirus-specific immunoglobulins in patients with COPD with respect to clinical outcome.


METHODS
The presence of adenovirus-specific immunoglobulins during acute exacerbation of COPD (AECOPD) was analyzed at exacerbation and 2 to 3 weeks later. Patients with detectable adenovirus-specific IgM and low IgG avidity were grouped into fast and delayed IgG maturation. The clinical outcome of both groups was evaluated.


RESULTS
Of 208 patients, 43 (20.7%) had serologic evidence of recent adenovirus infection and were grouped by fast IgG maturation (26 patients) and delayed IgG maturation (17 patients). Baseline characteristics, AECOPD therapy, and duration of hospitalization were similar in both groups, but the AECOPD recurrence rate within 6 months was higher (P = .003), and there was a trend for earlier AECOPD-related rehospitalizations (P = .061) in the delayed IgG maturation group. The time to rehospitalization or death within 2 years was shorter in patients with delayed IgG maturation (P = .003). Adenovirus-specific IgG maturation was an independent predictor of the number of AECOPD recurrences within 6 months (P = .001) and the occurrence of hospitalization or death within 2 years (P = .005).


CONCLUSIONS
Delayed immunoglobulin avidity maturation following COPD exacerbation is associated with worse outcomes.


BACKGROUND
ISRCTN Register; No.: ISRCTN77261143; URL: www.isrctn.org.
Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch), University Basel, Basel; Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland.
Lucas
L
Boeck
Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch), University Basel, Basel; Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland.
Mikael
M
Gencay
Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch), University Basel, Basel; Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland.
Michael
M
Roth
Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch), University Basel, Basel; Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland.
Hans H
HH
Hirsch
Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch), University Basel, Basel; Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland.
Mirjam
M
Christ-Crain
Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch), University Basel, Basel; Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland.
Beat
B
Mueller
Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch), University Basel, Basel; Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland.
Michael
M
Tamm
Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch), University Basel, Basel; Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland. Electronic address: daiana.stolz@usb.ch.
Daiana
D
Stolz
D000256:Adenoviridae / Q000276:immunology*; D000257:Adenoviridae Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D053301:B-Cell Maturation Antigen / Q000276:immunology* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007111:Immunity, Cellular; D007074:Immunoglobulin G / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000276:immunology* / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology
D000998:Antiviral Agents; D053301:B-Cell Maturation Antigen; D015415:Biomarkers; D007074:Immunoglobulin G