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Original Research: COPD |

Systemic Inflammatory Pattern of Patients With Community-Acquired Pneumonia With and Without COPDInflammatory Response in Pneumonia with COPD

Ernesto Crisafulli, MD, PhD, FCCP; Rosario Menéndez, MD, PhD; Arturo Huerta, MD; Raquel Martinez, MD; Beatriz Montull, MD; Enrico Clini, MD, FCCP; Antoni Torres, MD, PhD, FCCP
Author and Funding Information

From the Department of Pulmonary Rehabilitation (Drs Crisafulli and Clini), Ospedale Villa Pineta, University of Modena and Reggio Emilia, Modena, Italy; Servicio de Neumología (Drs Menéndez, Martinez, and Montull), Hospital Universitario y politecnico La Fe, CIBERES, Valencia, Spain; and Pneumology Department (Drs Huerta and Torres), Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.

Correspondence to: Antoni Torres, MD, PhD, FCCP, Pneumology Department, Clinic Institute of Thorax, Hospital Clinic, Villarroel 170. 08036 Barcelona, Spain; e-mail: ATORRES@clinic.ub.es


Funding/Support: This study was supported by Ciber de Enfermedades Respiratorias [CIBERES (Biomedical Research Centre Network for Respiratory Diseases) CB06/06/0028], Pneumonia Corporate Research Program [2009 SGR 911], and by a grant from Marato TV3, Spain.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):1009-1017. doi:10.1378/chest.12-1684
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Background:  Several clinical studies have evaluated the role of COPD in patients with community-acquired pneumonia (CAP). We investigated the systemic inflammatory response of patients with CAP (CAP + COPD) and patients without associated COPD (CAP only).

Methods:  Clinical, microbiologic, and immunologic data were collected from 367 prospective patients on admission to hospital during a 3-year period. Comparative analyses were performed between patients with CAP + COPD (n = 117) and those with CAP only (n = 250) and between patients with and without domiciliary use of inhaled corticosteroids (ICSs) and oral corticosteroids.

Results:  Detailed characteristics of clinical severity and prognosis (mortality on hospitalization and at 30 and 90 days) were similar between the CAP + COPD and CAP-only groups. The readmission rate and the frequency of previous pneumonia were higher in the group of patients with CAP + COPD. On day 1 (admission to hospital), patients with CAP + COPD had significantly lower serum levels of tumor necrosis factor-α, IL-1, and IL-6 compared with the CAP-only group; levels of the remaining inflammatory biomarkers (C-reactive protein, procalcitonin, IL-8, and IL-10) were similar at days 1 and 3. The exclusion of patients with domiciliary use of ICS and oral corticosteroids confirmed lower levels of TNF-α on day 1 in patients with CAP + COPD. Finally, lower levels of IL-6 were found only among those patients with COPD who were currently using ICS.

Conclusions:  Our prospective study demonstrates a different, disease-specific, early inflammatory pattern between patients with CAP with and without associated COPD. These findings are not completely corticosteroid mediated.

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