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Study of serum C-reactive protein levels in acute exacerbations of chronic obstructive pulmonary disease patients

Sourabh Pahuja, Prashant Yadav, Aditya Kumar Gautam, Anand Kumar, Avdhesh Kumar, Sudhir Chaudhri.

Background: C-reactive protein (CRP) is an acute phase protein synthesized in response to tissue damage or inflammation and reflects total systemic burden of inflammation in individuals.

Objective: To assess the levels of serum CRP in acute exacerbations of chronic obstructive pulmonary disease (COPD) and wherever possible compare it with their stable state and to evaluate clinical severity of exacerbations viz a viz rise in serum CRP.

Materials and Methods: It was a prospective study in which cases (76) were patients with acute exacerbation of COPD and control group (30) comprised of patients with acute exacerbation of other respiratory diseases such as pneumonia (15 patients), acute exacerbation of asthma (10 patients), and 5 patients of acute respiratory distress syndrome (ARDS). CRP measurement was done by Nephlometry. CRP levels were measured at time of exacerbation and at time of recovery of the patients, which were compared with the overall prognosis of the patients and with the duration and stage of COPD and also the prognosis of patients in each group is correlated to CRP levels. To achieve this objective, receiver operating characteristic curve analysis has been used with the help of MedCalc software and logistic regression analysis has been used to study the role of different stages of COPD and role of comorbidity in the final outcome of the patients using SPSS software version 22.

Result: The serum CRP was significantly elevated in patients with COPD with acute exacerbation (mean value 14.78 mg/dL). There was significant elevation of CRP values in control group such as in asthma (mean value 2.71 mg/dL), pneumonia (mean value 20.28 mg/dL), and ARDS (mean value 27.02 mg/dL).

Conclusion: CRP is a good discriminator and it predicts poor outcome and also predicts admission in intensive care unit (ICU) or in ward for the patients of acute exacerbation of COPD. CRP value higher than 17.5 mg/dL and above had the poor final outcome of treatment. Positive correlation was found between CRP value and admission in ICU.

Key words: Chronic obstructive pulmonary disease, C-reactive protein, inflammatory marker

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