Inflammatory Biomarkers Improve Clinical Prediction of Mortality in Chronic Obstructive Pulmonary Disease.
Am J Respir Crit Care Med. 2012 Mar 15;
Authors: Celli BR, Locantore N, Yates J, Tal-Singer R, Miller BE, Bakke P, Calverley P, Coxson H, Crim C, Edwards LD, Lomas DA, Duvoix A, Macnee W, Rennard S, Silverman E, Vestbo J, Wouters E, Agusti AA,
Abstract
Rationale Accurate prediction of mortality helps select patients for interventions aimed at improving outcome. Objectives Because chronic obstructive pulmonary disease is characterized by low-grade systemic inflammation, we hypothesized that addition of inflammatory biomarkers to established predictive factors will improve accuracy. Methods 1843 patients enrolled in the ECLIPSE study were followed for 3 years. Kaplan-Meier curves, log rank analysis and Cox proportional hazards analyses determined the predictive value for mortality of clinical variables, while C-statistics assessed the added discriminative power offered by addition of biomarkers. Measurements At recruitment we measured anthropometrics, spirometry, 6 minute walk distance, dyspnea, BODE index, history of hospitalization, co-morbidities and CT scan emphysema. White blood cell and neutrophil counts, serum or plasma levels of fibrinogen, chemokine ligand 18, surfactant protein D, C-reactive protein , Clara cell secretory protein-16, Interleukin-6 and -8 and tumor necrosis factor alpha were determined at recruitment and subsequent visits.. Main Results 168 of the 1843 patients (9•1 %) died. Non-survivors were older, had more severe airflow limitation, increased dyspnea, higher BODE score, more emphysema, and higher rates of co-morbidities and history of hospitalizations. The best predictive model for mortality using clinical variables included age, BODE and hospitalization history (C-statistic of 0•686, p<0•001). One single biomarker (Interleukin-6) significantly improved the C statistic to 0.708, but this was further improved to 0•726, (p=0•003) by the addition of all biomarkers. Conclusions The addition of a panel of selected biomarkers improves the ability of established clinical variables to predict mortality in COPD.
PMID: 22427534 [PubMed - as supplied by publisher]