Persistent Systemic Inflammation is Associated with Poor Clinical Outcomes in COPD: A Novel Phenotype

By Alvar Agusti, L. Edwards, S. Rennard, W. Macnee, R. Tal-Singer, B. Miller, Jorgen Vestbo, D. Lomas, P. Calverley, Emiel F. M. Wouters and 7 more. PLoS ONE, 2012

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Background Because chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, the identification of specific clinical phenotypes is key to developing more effective therapies. To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed patients recruited to the well-characterized ECLIPSE cohort (NCT00292552). Methods and Findings Six inflammatory biomarkers in peripheral blood (white blood cells (WBC) count and CRP, IL-6, IL-8, fibrinogen and TNF-α levels) were quantified in 1,755 COPD patients, 297 smokers with normal spirometry and 202 non-smoker controls that were followed-up for three years. We found that, at baseline, 30% of COPD patients did not show evidence of systemic inflammation whereas 16% had persistent systemic inflammation. Even though pulmonary abnormalities were similar in these two groups, persistently inflamed patients during follow-up had significantly increased all-cause mortality (13% vs. 2%, p<0.001) and exacerbation frequency (1.5 (1.5) vs. 0.9 (1.1) per year, p<0.001) compared to non-inflamed ones. As a descriptive study our results show associations but do not prove causality. Besides this, the inflammatory response is complex and we studied only a limited panel of biomarkers, albeit they are those investigated by the majority of previous studies and are often and easily measured in clinical practice. Conclusions Overall, these results identify a novel systemic inflammatory COPD phenotype that may be the target of specific research and treatment.

Subfields: Epidemiology, Immunology, Pulmonary and Respiratory Medicine

View Paper: https://www.semanticscholar.org/paper/f4672830dc24803baa849ce64fff7393bb7c81eb

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Citations in the corpus

Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. (2013, background): “However, the ECLIPSE study reported that chronic systemic inflammation is a feature in only a small proportion of the patients with COPD (19).”
Targeting interleukin-6 in inflammatory autoimmune diseases and cancers. (2014, background): “In two studies on inflammatory markers in chronic obstructive pulmonary disease (COPD), increased levels of IL-6 in serumwere shown to be predictive of increased mortality in COPD patients (Agusti et al., 2012; Celli et al., 2012).”