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Correlation of Inflammatory Markers and Nutritional Status With Severity of Disease in Patients With Stable Chronic Obstructive Pulmonary Disease (COPD) FREE TO VIEW

Sneh Arora, PhD; Randeep Guleria, DM; Guresh Kumar, PhD; Anant Mohan, MD
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All India Institute of Medical Sciences, New Delhi, India

Chest. 2010;138(4_MeetingAbstracts):690A. doi:10.1378/chest.10382
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PURPOSE: COPD is a systemic inflammatory disease where poor nutrition is associated with worse prognosis. We investigated to see whether inflammatory markers - serum C-reactive protein, leptin and nutritional status (prealbumin and anthropometry) correlated with the severity of the disease.

METHODS: Sixty six stable COPD patients (mean ± SD age 58.39±11.58 years) were recruited. Patients were classified on the basis of GOLD guidelines. Detailed clinical assessment was done in all. Concentration of serum C-reactive protein (CRP), prealbumin and leptin was measured. Anthropometry include body mass index (BMI), mid upper arm circumference (MUAC), sum of 4 skinfold thicknesses (triceps, biceps, suprailliac and subscapular) and 6 minute walk test was done.

RESULTS: Twelve patients had moderate (FEV1 62.92± 12.84 % predicted), 26 Severe (FEV1 39.31±5.66% predicted) and 28 very severe (FEV1 22.50± 4.30% predicted) COPD. Median (Interquantile range, IQR) levels of CRP in moderate, severe and very severe COPD was .35(.20-67), .85(.40-2.02), .55 (.22-1.5) mg/dl respectively. Median (IQR) level of prealbumin in moderate severe and very severe COPD 10.44 (.20-19.56) mg/dl 7.0 (1.04-15.60) mg/dl, 7.46 (1.04-14.98)mg/dl respectively. Median (IQR) level of leptin in moderate severe and very severe COPD 10.91(5.23-17.82)ng/mL, 1.35(.00-4.82)ng/mL, 1.05(.00-9.34)ng/mL respectively. Median (IQR) levels of BMI in three groups was 23.04 (20.90-25.47) kg/meter2, 19.03 (17.39-22.93) kg/meter2 and 18.04(26.50-.88 (± 3.18) kg/meter2 respectively. Sum of four skinfold thickness and mid upper arm circumference was significantly decreased in the more severe group. Severe COPD patients had a significantly lower prealbumin, leptin, BMI and decreased 6 minute walk test. Serum CRP was significantly raised in severe COPD.

CONCLUSION: Patients with severe COPD had a significantly decreased level of Leptin, prealbumin, BMI, MUAC and a decreased 6 minute walk test as compared to those with mild disease. CRP level increased with the severity of disease.

CLINICAL IMPLICATIONS: As COPD progresses inflammation and nutritional status deteriorates. This may be associated with a poor prognosis. Treatment in severe COPD should also be directed towards inflammation and nutritional status as this may improve prognosis.

DISCLOSURE: Sneh Arora, No Financial Disclosure Information; No Product/Research Disclosure Information

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