1. Chest 2008;133;1336-1343. Juan P. de Torres, Victor Pinto-Plata, Ciro Casanova, Hanna Mullerova, Elizabeth Córdoba-Lanús, Mercedes Muros de Fuentes, Armando Aguirre-Jaime and Bartolome R. Celli C-Reactive Protein Levels and Survival in Patients With Moderate to Very Severe COPD R1 Jo Wouk

2. Introduction Abnormal pulmonary inflammatory response to noxious particles or gases COPD Malnutrition Muscle wasting Osteoporosis Cardiovascular disease Type 2 DM AnemiaDepression Systemic effects

3. Continued… stable COPD patients Inflammatory markers increased Especially, CRP Especially, CRP Inflammatory markers increased Especially, CRP Especially, CRP

4. CRP levels (In stable COPD) directly associated with age, weight, dyspnea, QOL inversely related to exercise capacity / airway obstruction higher levels of CRP patients with COPD increase even more during exacerbations decrease in patients receiving inhaled corticosteroids

5. Purpose Previous epidemiologic studies increased CRP levels are independently associated with global and cardiovascular mortality in COPD patients with mild-to-moderate degrees of airway obstruction Previous epidemiologic studies increased CRP levels are independently associated with global and cardiovascular mortality in COPD patients with mild-to-moderate degrees of airway obstruction To explore whether CRP levels are associated with survival in patients whether CRP levels are associated with survival in patients with Moderate to Very Severe degree of airway obstruction with Moderate to Very Severe degree of airway obstruction To explore whether CRP levels are associated with survival in patients whether CRP levels are associated with survival in patients with Moderate to Very Severe degree of airway obstruction with Moderate to Very Severe degree of airway obstruction initial CRP level *BODE, PaO 2, IC/TLC (* BMI, obx, dyspnea,exercise capacity) initial CRP level *BODE, PaO 2, IC/TLC (* BMI, obx, dyspnea,exercise capacity) Risk of death

6. Materials and Method Inclusion criteria 1. smoking more than 20 pack-years 1. smoking more than 20 pack-years 2. postbronchodilator FEV1/FVC ratio < 0.7 2. postbronchodilator FEV1/FVC ratio < 0.7 (after 400 g of inhaled albuterol) (after 400 g of inhaled albuterol) 3. clinically stable (no exacerbation for 2 mo.) 3. clinically stable (no exacerbation for 2 mo.) at the time of the evaluation at the time of the evaluation Inclusion criteria 1. smoking more than 20 pack-years 1. smoking more than 20 pack-years 2. postbronchodilator FEV1/FVC ratio < 0.7 2. postbronchodilator FEV1/FVC ratio < 0.7 (after 400 g of inhaled albuterol) (after 400 g of inhaled albuterol) 3. clinically stable (no exacerbation for 2 mo.) 3. clinically stable (no exacerbation for 2 mo.) at the time of the evaluation at the time of the evaluation Exclusion criteria asthma, bronchiectasis, tuberculosis, malignancy, arthritis, asthma, bronchiectasis, tuberculosis, malignancy, arthritis, connective tissue disorders, IBD connective tissue disorders, IBD Exclusion criteria asthma, bronchiectasis, tuberculosis, malignancy, arthritis, asthma, bronchiectasis, tuberculosis, malignancy, arthritis, connective tissue disorders, IBD connective tissue disorders, IBD

7. RESULT

8. Baseline characteristics 1

9. Baseline characteristics 2

10. Survivors vs Nonsurvivors

11. Higher CRP vs Lower CRP

12. Cox proportional hazard regression analysis most of the evaluated variables were associated with all-cause mortality, whereas the CRP did not most of the evaluated variables were associated with all-cause mortality, whereas the CRP did not

14. Conclusion 1. In moderate to very severe COPD patients, CRP levels are not associated with survival status CRP levels are not associated with survival status 2. Other long-term studies in different settings are needed to evaluate the role of CRP and other markers in patients with clinical COPD 1. In moderate to very severe COPD patients, CRP levels are not associated with survival status CRP levels are not associated with survival status 2. Other long-term studies in different settings are needed to evaluate the role of CRP and other markers in patients with clinical COPD