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Original Research: COPD |

Systemic Biomarkers in Exacerbations of COPDSystemic Biomarkers in COPD Exacerbations: The Evolving Clinical Challenge

Angela Koutsokera, MD; Daiana Stolz, MD, FCCP; Stelios Loukides, MD, FCCP; Konstantinos Kostikas, MD, FCCP
Author and Funding Information

From the Service de Pneumologie et Rehabilitation Respiratoire (Dr Koutsokera), Hôpital de Rolle, Switzerland; Clinic for Pulmonary Medicine and Respiratory Cell Research (Dr Stolz), University Hospital Basel, Switzerland; and Second Respiratory Medicine Department (Drs Loukides and Kostikas), University of Athens Medical School, Athens, Greece.

Correspondence to: Konstantinos Kostikas, MD, FCCP, Stamouli 3, Karditsa 43100, Greece; e-mail: ktk@otenet.gr


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):396-405. doi:10.1378/chest.11-0495
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Background:  Exacerbations of COPD (ECOPD) remain a major cause of mortality and morbidity. Despite advances in the understanding of their pathophysiology, their assessment relies primarily on clinical presentation, which can be variable and difficult to predict. A large number of biomarkers already have been assessed in this context, and some appear to be promising.

Methods:  An online search for articles published until December 2010 was conducted using three terms for ECOPD, five terms for biomarkers, and five terms for the sampling method. Biomarkers were evaluated for their potential role in the establishment and confirmation of the diagnosis of ECOPD, the evaluation of etiology and severity, the prediction of prognosis, and the guidance of treatment decisions.

Results:  Several systemic biomarkers have been measured in the context of ECOPD, and most have been found to increase at ECOPD onset and to subside during the course of exacerbations. Correlations have been reported among these biomarkers, but direct associations with clinical variables have been more difficult to establish. Although there are several limitations yet to be addressed, some of the biomarkers, most notably C-reactive protein for the identification of an ECOPD and procalcitonin for antibiotic guidance, may provide clinically relevant information.

Conclusions:  So far, no single biomarker has been able to gain wide acceptance, but some provide clinically useful information. The evaluation of such biomarkers in large decision-making studies is expected to become an area of intense investigation in the near future.

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