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Original Research: COPD |

Pneumonic and Nonpneumonic Exacerbations of COPDCharacteristics of Inflammatory COPD Profiles: Inflammatory Response and Clinical Characteristics

Arturo Huerta, MD; Ernesto Crisafulli, MD, PhD, FCCP; Rosario Menéndez, MD, PhD; Raquel Martínez, MD; Néstor Soler, MD, PhD; Mónica Guerrero, MD; Beatriz Montull, MD; Antoni Torres, MD, PhD, FCCP
Author and Funding Information

From the Pneumology Department (Drs Huerta, Soler, and Guerrero and Prof Torres), Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain; the Department of Medical and Surgical Sciences (Dr Crisafulli), University of Modena and Reggio Emilia, Modena, Italy; and the Pneumology Department (Drs Menéndez, Martinez, and Montull), Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain.

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


Funding/Support: This manuscript was supported by a grant from La Marató TV3.

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


Chest. 2013;144(4):1134-1142. doi:10.1378/chest.13-0488
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Background:  Community-acquired pneumonia (CAP) is a frequent event in patients with COPD, although it is not currently considered an acute exacerbation of COPD (AECOPD). To our knowledge, no studies have compared the inflammatory response of patients with COPD who develop CAP or AECOPD. The aim of our study was to compare clinical and evolutive manifestations and biologic signaling of AECOPD and CAP + COPD.

Methods:  Prospective data were collected from 249 consecutively hospitalized patients with COPD. Comparative analyses were performed in patients with AECOPD (n = 133) and patients with CAP + COPD (n = 116). Measures of clinical characteristics, blood biomarkers, and evolution were recorded on admission, after 3 and 30 days, and in a follow-up period of 30 days, 90 days, and 1 year.

Results:  Patients with CAP + COPD had higher FEV1 compared with patients with COPD without pneumonia. In-hospital and long-term outcomes (1 year) were similar for both populations. However, patients with AECOPD had more readmissions, and patients with CAP had more prior episodes of pneumonia. At day 1 and day 3, patients with CAP + COPD had significantly (P < .001) higher serum levels of C-reactive protein (CRP), procalcitonin, tumor necrosis factor-α, and IL-6. Repetition of the analyses after stratifying patients based on severity of disease, current inhaled pharmacotherapy, and noninfectious AECOPD cause confirmed higher levels of the same biomarkers in patients with CAP + COPD. Chills, pleuritic pain, sputum purulence, and CRP levels at day 1 were independent clinical predictors of CAP + COPD.

Conclusions:  Our study confirms that two different clinical and inflammatory profiles exist in hospitalized patients with COPD in response to CAP (stronger response) and AECOPD, although with similar short-term and long-term outcomes.

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