Inflammatory biomarkers and comorbidities in chronic obstructive pulmonary disease

TY - JOUR

T1 - Inflammatory biomarkers and comorbidities in chronic obstructive pulmonary disease

AU - Thomsen, Mette

AU - Dahl, Morten

AU - Lange, Peter

AU - Vestbo, Jørgen

AU - Nordestgaard, Børge G

PY - 2012/11/15

Y1 - 2012/11/15

N2 - Rationale: Patients with chronic obstructive pulmonary disease (COPD) have evidence of systemic inflammation that may be implicated in the development of comorbidities. Objectives: To test the hypothesis that elevated levels of three inflammatory biomarkers are associated with increased risk of comorbidities in COPD. Methods:We examined 8,656 patients withCOPDfrom two large Danish population studies andduringa median 5 years' follow-up recorded hospital admissions due to major comorbidities as endpoints. Measurements and Main Results: We measured baseline C-reactive protein (CRP), fibrinogen,and leukocyte count,andrecorded admissions due to ischemic heart disease, myocardial infarction, heart failure, type II diabetes, lung cancer, pneumonia, pulmonary embolism, hip fracture, and depression for all participants. Multifactorially adjusted risk of ischemic heart disease was increased by a factor of 2.19 (95% confidence interval, 1.48-3.23) in individuals with three biomarkers elevated (CRP > 3mg/L, fibrinogen > 14 mmol/L, and leukocyte count > 9×109/L) versus individuals with all three biomarkers at or below these limits. Corresponding hazard ratios were 2.32 (1.34-4.04) formyocardial infarction, 2.63 (1.71-4.04) for heart failure, 3.54 (2.03-6.19) for diabetes, 4.00 (2.12-7.54) for lung cancer, and 2.71 (2.03-3.63) forpneumonia.Therewerenoconsistentdifferences in risk of pulmonary embolism, hip fracture, or depression as a function of these three biomarkers. Conclusions: Simultaneously elevated levels of CRP, fibrinogen, and leukocyte count are associated with a two-to four fold increased risk of major comorbidities in COPD. These biomarkersmay be an additional tool for clinicians to conduct stratified management of comorbidities in COPD.

AB - Rationale: Patients with chronic obstructive pulmonary disease (COPD) have evidence of systemic inflammation that may be implicated in the development of comorbidities. Objectives: To test the hypothesis that elevated levels of three inflammatory biomarkers are associated with increased risk of comorbidities in COPD. Methods:We examined 8,656 patients withCOPDfrom two large Danish population studies andduringa median 5 years' follow-up recorded hospital admissions due to major comorbidities as endpoints. Measurements and Main Results: We measured baseline C-reactive protein (CRP), fibrinogen,and leukocyte count,andrecorded admissions due to ischemic heart disease, myocardial infarction, heart failure, type II diabetes, lung cancer, pneumonia, pulmonary embolism, hip fracture, and depression for all participants. Multifactorially adjusted risk of ischemic heart disease was increased by a factor of 2.19 (95% confidence interval, 1.48-3.23) in individuals with three biomarkers elevated (CRP > 3mg/L, fibrinogen > 14 mmol/L, and leukocyte count > 9×109/L) versus individuals with all three biomarkers at or below these limits. Corresponding hazard ratios were 2.32 (1.34-4.04) formyocardial infarction, 2.63 (1.71-4.04) for heart failure, 3.54 (2.03-6.19) for diabetes, 4.00 (2.12-7.54) for lung cancer, and 2.71 (2.03-3.63) forpneumonia.Therewerenoconsistentdifferences in risk of pulmonary embolism, hip fracture, or depression as a function of these three biomarkers. Conclusions: Simultaneously elevated levels of CRP, fibrinogen, and leukocyte count are associated with a two-to four fold increased risk of major comorbidities in COPD. These biomarkersmay be an additional tool for clinicians to conduct stratified management of comorbidities in COPD.

KW - Aged

KW - Biological Markers

KW - C-Reactive Protein

KW - Diabetes Mellitus, Type 2

KW - Female

KW - Fibrinogen

KW - Forced Expiratory Volume

KW - Heart Failure

KW - Humans

KW - Inflammation Mediators

KW - Leukocyte Count

KW - Lung Neoplasms

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Myocardial Ischemia

KW - Pneumonia

KW - Pulmonary Disease, Chronic Obstructive

KW - Risk

KW - Vital Capacity

U2 - 10.1164/rccm.201206-1113oc

DO - 10.1164/rccm.201206-1113oc

M3 - Journal article

C2 - 22983959

SN - 1073-449X

VL - 186

SP - 982

EP - 988

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 10

ER -