Inflammation

, Volume 36, Issue 5, pp 1122–1128 | Cite as

Serum C-reactive Protein Level and Distribution in Chronic Obstructive Pulmonary Disease Versus Healthy Controls: a Case–Control Study from Iran

  • Alireza Firouzjahi
  • Mahmoud Monadi
  • Fatemeh Karimpoor
  • Behzad Heidari
  • Yahya Dankoob
  • Karim Hajian-Tilaki
  • Mokarraram Gorgani Firozjaii
Article

ABSTRACT

Inflammation has a contributive role in the development and progression of chronic obstructive pulmonary disease (COPD).The present study was designed to determine the level and the distribution of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in COPD compared with controls. Ninety patients with COPD presented to an outpatient hospital clinic and 50 controls who were selected among personals of the same hospital entered the study. Serum high sensitive CRP (hs-CRP) was measured by immunoturbidimetric method and the ESR by Westergren method. Receiver operating characteristic curve was applied to determine a cutoff point for differentiation of the COPD and control group. In statistical analysis, the patients and controls were compared regarding levels and distribution of hs-CRP and ESR. Mean age of patients and controls was 67 ± 11.6 and 51.3 ± 6.7 years, respectively (p = 0.001). Mean hs-CRP was significantly higher (4.76 ± 5.6 vs 1.72 ± 1.68 mg/L, p = 0.001) but mean ESR was nonsignificantly higher (9.1 ± 11.2 vs 7.2 ± 7.4 m/h, p = 0.95) in patients than control. Serum hs-CRP at 1.55 mg/L, differentiated patients and controls at sensitivity of 77.3 % and specificity of 60 %. Serum hs-CRP >3 mg/L was observed in 39 (44.3 %) patients and 9 (18 %) controls (p = 0.001) and >6 mg/L in 22 (25 %) patients and 2 (4 %) controls (p = 0.001).Serum hs-CRP was significantly correlated with ESR in patient but not in control group (Spearman correlation coefficient = 0.516, p = 0.001). Serum hs-CRP and ESR was not correlated with age, weigh, smoking, and the severity of COPD. The results of this study indicated a systemic inflammatory process in COPD. Since inflammation has an important contribution in development of future pulmonary and extrapulmonary complications, serum CRP assessment will provide additional information beyond that achieved by conventional method of pulmonary function test.

KEY WORDS

chronic obstructive pulmonary disease (COPD) high sensitive CRP erythrocyte sedimentation rate (ESR) inflammation 

REFERENCES

  1. 1.
    Chung, K.F., and I.M. Adcock. 2008. Multifaceted mechanisms in COPD: inflammation, immunity, and tissue repair and destruction. Eur Respir J 31: 1334–56.PubMedCrossRefGoogle Scholar
  2. 2.
    Wouters, E. 2009. COPD: from obstructive lung disease to chronic systemic inflammatory syndrome? Pneumologie 63: S107–12 [In German].PubMedCrossRefGoogle Scholar
  3. 3.
    Sevenoaks, M.J., and R.A. Stockley. 2006. Chronic obstructive pulmonary disease, inflammation and co-morbidity—a common inflammatory phenotype? Respir Res 7: 70,1–9.CrossRefGoogle Scholar
  4. 4.
    Fabbri, L.M., F. Luppi, B. Beghe, and K.F. Rabe. 2008. Complex chronic comorbidities of COPD. Eur Respir J 31: 204–12.PubMedCrossRefGoogle Scholar
  5. 5.
    Oudijk, E.J., J.W. Lammers, and L. Koenderman. 2003. Systemic inflammation in chronic obstructive pulmonary disease. Eur Respir J 46: 5s–13s.CrossRefGoogle Scholar
  6. 6.
    Heidari, B., P. Heidari, and M.E. Tayebi. 2007. The value of changes in CRP and ESR for predicting treatment response in rheumatoid arthritis. APLAR J Rheumatol 10: 23–8.CrossRefGoogle Scholar
  7. 7.
    Bedel, S.E., and B.T. Bush. 1985. Erythrocyte sedimentation rate from folklore to fact. Am J Med. 78: 1001–9.CrossRefGoogle Scholar
  8. 8.
    Heidari, B. 2012. The importance of C-reactive protein and other inflammatory markers in patients with chronic obstructive pulmonary disease. Caspian J Intern Med. 3: 428–435.Google Scholar
  9. 9.
    Tofan, F., M.H. Rahimi-Rad, Y. Rasmi, and S. Rahimirad. 2012. High sensitive C-reactive protein for prediction of adverse outcome in acute exacerbation of chronic obstructive pulmonary disease. Pneumologia. 61: 160–2.PubMedGoogle Scholar
  10. 10.
    Dahl, M., J. Vestbo, P. Lange, S.E. Bojesen, A. Tybjaerg-Hansen, and B.G. Nordestgaard. 2007. C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 175: 250–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Hurst, J.R., G.C. Donaldson, W.R. Perera, T.M. Wilkinson, J.A. Bilello, G.W. Hagan, R.S. Vessey, and J.A. Wedzicha. 2006. Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 174: 867–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Patel, A.R., J.R. Hurst, and J.A. Wedzicha. 2010. The potential value of biomarkers in diagnosis and staging of COPD and exacerbations. Semin Respir Crit Care Med 31: 267–75.PubMedCrossRefGoogle Scholar
  13. 13.
    Sin, D.D., P. Lacy, E. York, and S.F. Man. 2004. Effects of fluticasone on systemic markers of inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 170: 760–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Man, S.F., J.E. Connett, N.R. Anthonisen, R.A. Wise, D.P. Tashkin, and D.D. Sin. 2006. C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease. Thorax 61: 849–53.PubMedCrossRefGoogle Scholar
  15. 15.
    de Torres, J.P., V. Pinto-Plata, C. Casanova, H. Mullerova, E. Córdoba-Lanús, M. Muros de Fuentes, A. Aguirre-Jaime, and B.R. Celli. 2008. C-reactive protein levels and survival in patients with moderate to very severe COPD. Chest 133: 1336–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Zhang, Y.H., L.J. Guo, G. Kuang, M. Zhu, and L.R. Liang. 2010. Association between the erythrocyte sedimentation rate, serum C-reactive protein and risk of lung cancer. Zhonghua Zhong Liu Za Zhi 32: 48–51 [In Chinese].PubMedGoogle Scholar
  17. 17.
    Sin, D.D., and S.F. Man. 2003. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 107(11): 1514–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Piehl-Aulin, K., I. Jones, B. Lindvall, A. Magnuson, and S.M. Abdel-Halim. 2009. Increased serum inflammatory markers in the absence of clinical and skeletal muscle inflammation in patients with chronic obstructive pulmonary disease. Respiration 78: 191–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Karadag, F., S. Kirdar, A.B. Karul, and E. Ceylan. 2008. The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med 19: 104–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Zhang, Y., H. Bunjhoo, W. Xiong, Y. Xu, and D. Yang. 2012. Association between C-reactive protein concentration and chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Int Med Res. 40: 1629–35.PubMedCrossRefGoogle Scholar
  21. 21.
    Thorleifsson, S.J., O.B. Margretardottir, G. Gudmundsson, I. Olafsson, B. Benediktsdottir, C. Janson, A.S. Buist, and T. Gislason. 2009. Chronic airflow obstruction and markers of systemic inflammation: results from the BOLD study in Iceland. Respir Med 103: 1548–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Valipour, A., M. Schreder, M. Wolzt, S. Saliba, S. Kapiotis, P. Eickhoff, and O.C. Burghuber. 2008. Circulating vascular endothelial growth factor and systemic inflammatory markers in patients with stable and exacerbated chronic obstructive pulmonary disease. Clin Sci (Lond) 115: 225–32.CrossRefGoogle Scholar
  23. 23.
    Saetta, M. 1999. Airway inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 160: S17–20.PubMedCrossRefGoogle Scholar
  24. 24.
    Gan, W.Q., S.F. Man, A. Senthilselvan, and D.D. Sin. 2004. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax. 59: 574–80.PubMedCrossRefGoogle Scholar
  25. 25.
    Kushner, I. 1982. The phenomenon of the acute phase response. Ann N Y Acade Sci. 389: 39–48.CrossRefGoogle Scholar
  26. 26.
    Osei-Bimpong, A., J.H. Meek, and S.M. Lewis. 2007 Aug. Hematology. 2007 Aug;12(4):353-7.ESR or CRP? A comparison of their clinical utility. Hematology 12(4): 353–7.Google Scholar
  27. 27.
    Pauwels, R.A., A.S. Buist, P. Ma, C.R. Jenkins, and S.S. Hurd. 2001. GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. Respir Care 46(8): 798–825. Review.PubMedGoogle Scholar
  28. 28.
    Pfützner, A., and T. Forst. 2006. High-sensitivity C-reactive protein as cardiovascular risk marker in patients with diabetes mellitus. Diabetes Technol Ther. 8: 28–36.PubMedCrossRefGoogle Scholar
  29. 29.
    Bircan, A., M. Gokirmak, O. Kilic, O. Ozturk, and A. Akkaya. 2008. C-reactive protein levels in patients with chronic obstructive pulmonary disease: role of infection. Med Princ Pract 17: 202–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Corsonello, A., C. Pedone, S. Battaglia, G. Paglino, V. Bellia, and R. Incalzi. 2011. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as inflammation markers in elderly patients with stable chronic obstructive pulmonary disease (COPD). Arch Gerontol Geriatr 53(2): 190–5. doi:10.1016/j.archger.2010.10.015. Epub 2010 Nov 12.PubMedCrossRefGoogle Scholar
  31. 31.
    Feldman, M., B. Aziz, G.N. Kang, M.A. Opondo, R.K. Belz, and C. Sellers. 2013. C-reactive protein and erythrocyte sedimentation rate discordance: frequency and causes in adults. Transl Res 161(1): 37–43. doi:10.1016/j.trsl.2012.07.006. Epub 2012 Aug 23.PubMedCrossRefGoogle Scholar
  32. 32.
    Garcia-Rio, F., M. Miravitlles, J.B. Soriano, L. Muñoz, E. Duran-Tauleria, G. Sánchez, V. Sobradillo, and J. Ancochea. 2010. EPI-SCAN Steering Committee. Systemic inflammation in chronic obstructive pulmonary disease: a population-based study. Respir Res 11: 63. doi:10.1186/1465-9921-11-63.PubMedCrossRefGoogle Scholar
  33. 33.
    Kirdar, S., M. Serter, E. Ceylan, A.G. Sener, T. Kavak, and F. Karadağ. 2009. Adiponectin as a biomarker of systemic inflammatory response in smoker patients with stable and exacerbation phases of chronic obstructive pulmonary disease. Scand J Clin Lab Invest 69(2): 219–24. doi:10.1080/00365510802474400.PubMedCrossRefGoogle Scholar
  34. 34.
    Lazovic, B. 2012. Correlation of CRP and serum level of fibrinogen with severity of disease in chronic obstructive pulmonary disease patients. Med Arh 66(3): 159–60.PubMedCrossRefGoogle Scholar
  35. 35.
    Peng, C., C. Tian, Y. Zhang, X. Yang, and Y. Feng. 2013 Mar. Fan H.C-reactive protein levels predict bacterial exacerbation in patients with chronic obstructive pulmonary disease. Am J Med Sci 345(3): 190–4.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Alireza Firouzjahi
    • 1
  • Mahmoud Monadi
    • 2
  • Fatemeh Karimpoor
    • 2
  • Behzad Heidari
    • 2
  • Yahya Dankoob
    • 2
  • Karim Hajian-Tilaki
    • 3
  • Mokarraram Gorgani Firozjaii
    • 2
  1. 1.Department of Laboratory Medicine, Rouhani hospitalBabol University of Medical SciencesBabolIran
  2. 2.Department Internal Medicine, Rouhani hospitalBabol University of Medical SciencesBabolIran
  3. 3.Department of Social MedicineBabol University of Medical SciencesBabolIran

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