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Original Research: COPD |

Adenovirus-Specific IgG Maturation as a Surrogate Marker in Acute Exacerbations of COPDAdenovirus IgG Maturation in COPD

Lucas Boeck, MD; Mikael Gencay, PhD; Michael Roth, PhD; Hans H. Hirsch, MD; Mirjam Christ-Crain, MD; Beat Mueller, MD; Michael Tamm, MD, FCCP; Daiana Stolz, MD, MPH
Author and Funding Information

From the Clinic of Pulmonary Medicine and Pulmonary Cell Research (Drs Boeck, Gencay, Roth, Tamm, and Stolz), University Hospital Basel, Basel; Department of Biomedicine (Dr Hirsch) and Department of Endocrinology, Diabetes and Metabolism (Dr Christ-Crain), University Basel, Basel; and Medical University Department (Dr Mueller), Kantonsspital Aarau, Aarau, Switzerland.

CORRESPONDENCE TO: Daiana Stolz, MD, MPH, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; e-mail: daiana.stolz@usb.ch


Drs Boeck and Gencay contribute equally to this work.

FUNDING/SUPPORT: Dr Christ-Crain was supported by the Swiss National Foundation [PP00P3_123346]. Dr Stolz was supported by the Swiss National Foundation [PP00P3_128412/1], the Liechtenstein Foundation, and the Freiwillige Akademische Gesellschaft Basel. Additional funding was granted by the Clinic of Pulmonary Medicine, University Hospital Basel, Basel, Switzerland.

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


Chest. 2014;146(2):339-347. doi:10.1378/chest.13-2307
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BACKGROUND:  B cells in airways and lung parenchyma may be involved in COPD evolution; however, whether their pathogenic role is beneficial or harmful remains controversial. The objective of this study was to investigate the maturation of adenovirus-specific immunoglobulins in patients with COPD with respect to clinical outcome.

METHODS:  The presence of adenovirus-specific immunoglobulins during acute exacerbation of COPD (AECOPD) was analyzed at exacerbation and 2 to 3 weeks later. Patients with detectable adenovirus-specific IgM and low IgG avidity were grouped into fast and delayed IgG maturation. The clinical outcome of both groups was evaluated.

RESULTS:  Of 208 patients, 43 (20.7%) had serologic evidence of recent adenovirus infection and were grouped by fast IgG maturation (26 patients) and delayed IgG maturation (17 patients). Baseline characteristics, AECOPD therapy, and duration of hospitalization were similar in both groups, but the AECOPD recurrence rate within 6 months was higher (P = .003), and there was a trend for earlier AECOPD-related rehospitalizations (P = .061) in the delayed IgG maturation group. The time to rehospitalization or death within 2 years was shorter in patients with delayed IgG maturation (P = .003). Adenovirus-specific IgG maturation was an independent predictor of the number of AECOPD recurrences within 6 months (P = .001) and the occurrence of hospitalization or death within 2 years (P = .005).

CONCLUSIONS:  Delayed immunoglobulin avidity maturation following COPD exacerbation is associated with worse outcomes.

TRIAL REGISTRY:  ISRCTN Register; No.: ISRCTN77261143; URL: www.isrctn.org

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