PURPOSE: COPD is a disease with systemic inflammation. We studied the correlation between acute phase proteins (C-reactive protein, prealbumin and transferrin) and mortality in ventilated patients with COPD.
METHODS: 93 COPD patients with acute exacerbation and on invasive mechanical ventilation were evaluated. Detailed clinical evaluation was done daily. Concentration of C-reactive protein(CRP) and prealbumin(PA) was measured on admission, 3rd, 8th and 16th day. Serum transferrin was measured on admission, 8th and 16th day.
RESULTS: 49 patients were discharged and 44 died during the study. Median (interquartile range, IQR) levels of CRP at admission, 3rd , 8th and 16th day in survivors were 7.65(3.575-15.350) mg/dl, 5.20(2.50-9.35) mg/dl, 1.75(1.0-3.80) mg/dl and 1.00(0.70-4.30) mg/dl and were 12.30(4.60-23.0) mg/dl, 11.40(6.40-22.40) mg/dl, 5.70(2.60-14.0) mg/dl and 8.5(3.65-9.80) mg/dl respectively in those who died. The difference between the two groups was significant at admission, 3rd and 8th day. Median (IQR) levels of prealbumin on admission, 3rd , 8th and 16th day in survivors were 11.29(6.55-16.90) mg/dl, 11.34(8.08-17.25) mg/dl, 13.50(10.10-19.28) mg/dl, and 14.90(7.98-18.48) mg/dl respectively. There was a significant increase in these values with time (P<.001). In non survivors the values on these days were 10.45(7.23-14.16) mg/dl, 9.32(7.19-14.27) mg/dl, 12.36(5.53-17.42) mg/dl and 10.90(7.33-15.73) mg/dl respectively and the difference in the 380(99.0-175.63) mg/dl, 83.00(56.85-132.36) mg/dl respectively. In non survivors the values were 169.16(118.15-201.24) mg/dl, 155.07(130.60-198.93) mg/ two groups was not significant. Median (IQR) levels of serum transferrin at admission, 8th and 16th day in survivors were 152.48(118.00-187.00)mg/dl, 133.dl, 161.63(124.0-174.52) mg/dl respectively. The difference was significant only on 16th day.
CONCLUSIONS: CRP levels in patients who died was significantly higher on admission, 3rd ,8th and 16th day. A fall in CRP levels on follow up indicated a significantly better prognosis. An increase in the prealbumin level was observed in those who survived.
CLINICAL IMPLICATIONS: Persistently high CRP and low prealbumen in COPD patients on ventilator is associated with poor prognosis. Aggressive treatment of systemic inflammation and malnutrition may improve prognosis.
DISCLOSURE: The following authors have nothing to disclose: Randeep Guleria, Sneh Arora, Guresh Kumar, Anant Mohan
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