The relation among to mortality rate, hospitalization period and inflammatory mediators in patients with chronic obstructive pulmonary disease attack on admission to emergency department

Chronic obstructive pulmonary disease (COPD) is characterized by a progressive and not completely reversible obstruction of the airways associated with an abnormal inflammatory response of the lungs to particles and noxious gases related to a systemic effect. Inflammatory processes are suggested to be involved in pathogenesis of COPD. The aim of the study was to investigate the relation among to the mortality rate, hospitalization period and inflammatory mediators of the patients with COPD attack on admission into the emergency department. A total of 87 subjects with COPD attack were contributed in this study. TNF-α, IL-6 and catalase were determined in addition to leucocyte count (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). There was no significant difference between the deceased and discharged patients in terms of WBC, ESR, CRP, IL-6, and TNF-α. However, mean catalase levels of discharged patients were significantly higher than the deceased patients (p<0.05). Significant correlations were observed between WBC and hospitalization period, and CRP and follow up period in the intensive care unit. We can suggest that catalase activities on admission into the emergency service were decreased in deceased patients who were in follow up in intensive care unit with COPD attack. High CRP and WBC levels were also related with the hospitalization period of patients with COPD attack. 

___

  • Antonescu-Turcu, A.L., Tomic, R., 2009. C-reactive protein and copeptin: Prognostic predictors in chronic obstructive pulmonary disease exacerbations. Curr. Opin. Pulm. Med. 15, 120-125. doi: 10.1097/MCP.0b013e3283218603.
  • Bafadhel, M., Clark, T.W., Reid, C., Medina, M.J., Batham, S., Barer, M.R., Nicholson, K.G., Brightling, C.E., 2011. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest. 139, 1410-1418. doi: 10.1378/chest.10-1747.
  • Bhowmik, A., Seemungal, T.A., Sapsford, R.J., Wedzicha, J.A., 2000. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax. 55, 114-120.
  • Dahl, M., 2009. Genetic and biochemical markers of obstructive lung disease in the general population. Clin. Respir. J. 3, 121-122. doi: 10.1111/j.1752-699X.2008.00110.x.
  • Dahl, M., Nordestgaard B.G., 2009. Markers of early disease and prognosis in COPD. Int. J. Chron. Obsruct. Pulmon. Dis. 4, 157-167.
  • Daniels, J.M., Schoorl, M., Snijders, D., Knol, D.L., Lutter, R., Jansen, H.M., Boersma, W.G., 2010. Procalcitonin vs C-reactive protein as predictive markers of response to antibiotic theraphy in acute exacerbations of COPD. Chest. 138, 1108-1115. doi: 10.1378/chest.09-2927.
  • de Torres, J.P., Pinto-Plata, V., Casanova, C., Mullerova, H., Córdoba-Lanşs, E., Muros de Fuentes, M., Aguirre-Jaime, A., Celli, B.R., 2008. C-reactive protein levels and survival in patients with moderate to very severe COPD. Chest. 133, 1336-1343. doi: 10.1378/chest.07-2433.
  • Folchini, F., Nonato, N.L., Feofiloff, E., D’Almeida, V., Nascimento, O., Jardim, J.R., 2011. Association of oxidative stress markers and C-reactive protein with multidimensional indexes in COPD. Chron. Respir. Dis. 8, 101-108. doi: 10.1177/1479972310391284.
  • Fujimoto, K., Yasuo, M., Urushibata, K., Hanaoka, M., Koizumi, T., Kubo, K., 2005. Airway inflammation during stable and acutely exacerbated chronic obstructive pulmonary disease. Eur. Respir. J. 25, 640-646.
  • Garrod, R., Marshall, J., Barley, E., Fredericks, S., Hagan, G., 2007. The relationship between inflammatory markers and disability in chronic obstructive pulmonary disease (COPD). Prim. Care Respir. J. 16, 236-240.
  • Joppa, P., Petrasova, D., Stancak, B., Tkacova, R., 2006. Systemic inflammation in patients with COPD and pulmonary hypertension. Chest. 130, 326-333.
  • Kersul, A.L., Iglesias, A., Ríos, Á., Noguera, A., Forteza, A., Serra, E., Agustí, A., Cosío, B.G. 2011. Molecular mechanisms of inflammation during exacerbations of chronic obstructive pulmonary disease. Arch. Bronconeumol. 47, 176-183. doi: 10.1016/j.arbres.2010.12.003.
  • Ko, F.W., Leung T.F., Wong, G.W., Ngai J., To K.W., Ng S., Hui, D.S., 2009. Measurement of tumor necrosis factor-alpha, leukotriene B4, and interleukin 8 in the exhaled breath condensate in patients with acute exacerbations of chronic obstructive pulmonary disease. Int. J. Chron. Obstruct. Pulmon. Dis. 4, 79-86.
  • Lakhdar, R., Denden, S., Kassab, A., Leban, N., Knani, J., Lefranc, G., Miled, A., Chibani, J.B., Khelil, A.H., 2011. Update in chronic obstructive pulmonary disease: Role of antioxidant and metabolizing gene polimorphism. Exp. Lung Res. 37, 364-375. doi: 10.3109/01902148.2011.580416.
  • MacNee, W., 2001. Oxidative stress and lung inflammation in airways disease. Eur. J. Pharmacol. 429, 195-207.
  • MacNee, W., Rennard, S.I., Hunt, J.F., Edwards, L.D., Miller, B.E., Locantore, N.W., Tal-Singer, R., 2011. Evaluation of exhaled breath condensate pH as a biomarker for COPD. Respir Med. 105, 1037-1045. doi: 10.1016/j.rmed.2011.02.009.
  • Mak, J.C.W., 2008. Pathogenesis of COPD. Part II. Oxidative-antioxidative imbalance. Int. J. Tuberc. Lung Dis. 12, 368-374.
  • Man, S.F., Xing, L., Connett, J.E., Anthonisen, N.R., Wise, R.A., Tashkin, D.P., Zhang, X., Vessey, R., Walker, T.G., Celli, B.R., Sin, D.D., 2008. Circulating fibronectin to C-reactive protein ratio and mortality: A biomarker in COPD? Eur. Respir. J. 32, 1451-1457. doi: 10.1183/09031936.00153207.
  • Qiu, W., Cho, M.H., Riley, J.H., Anderson, W.H., Singh, D., Bakke, P., Gulsvik, A., Litonjua, A.A., Lomas, D.A., Crapo, J.D., Beaty, T.H., Celli, B.R., Rennard, S., Tal-Singer, R., Fox, S.M., Silverman, E.K., Hersh, C.P., ECLIPSE Investigators, 2011. Genetics of sputum gene expression in chronic obstructive pulmonary disease. PLoS One. 6, 24395. doi: 10.1371/journal.pone.0024395.
  • Rahman, I., Biswas, S.K., Kode, A., 2006. Oxidant and antioxidant balance in the airways and airway diseases. Eur. J. Pharmacol. 533, 222-239.
  • Ridker, P.M., Rifai, N., Stampfer, M.J., Hennekens, C.H., 2000. Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healty men. Circulation. 101, 1767-1762.
  • Stevans, T., Janssen, P.L., Tucker, A., 1992. Acute and long term TNF-α administration increases pulmonary vascular reactivity in isolated rat lungs. J. Appl. Physiol. 73, 708-712.