1 Role of CRP in Acute Exacerbation of Chronic Obstructive Pulmonary Disease 

Abstract : COPD, a common respiratory disease is currently the fourth leading cause of death in the world. The frequency and severity of disease exacerbation are the most important factors in determining the overall prognosis of COPD. Recent studies have shown that bacteria play an important role in the exacerbation of COPD, and up to 50% of exacerbations are caused by bacterial infections. In clinical practice increasing dyspnoea, increased sputum production and sputum purulence is used as an indicator to prescribe antibiotics. Serum C-reactive protein (CRP), a sensitive biomarker for systemic inflammation and tissue damage, is a good indicator of lower respiratory tract bacterial infection. Aim: This study was conducted to evaluate role of CRP in AECOPD, and whether it can guide the clinician to start prescribing appropriate antibiotics rationally in exacerbations of COPD and avoid indiscriminate use of antibiotics. Methodology: A total of 65 patients were included in this study over a period of 18 months conducted at Dhiraj Hospital, Pipariya, Gujarat and data was collected and compiled and studied using standard statistical methods. Results: The mean age of patients in the study was 60.7 years and there was male predominance in the ratio of 6.2:1. 78.46% patients had raised CRP levels (>6mg/dL). 56.9% of patients had bacterial aetiology for AECOPD, as identified from sputum evaluation and culture, of which more than 50% (19 out of 37patients) had positive sputum bacterial culture. On further evaluation it was found that only 8.1% patients with bacterial exacerbations had a normal CRP whereas 39.3% patients with nonbacterial exacerbation had normal CRP. This was statically significant (p value 0.006). The mean CRP levels too were significantly higher in bacterial exacerbations group ( p value 0.0011) The sensitivity of CRP (> 6 mg/dl) to detect bacterial AECOPD is 91.8% and specificity is 39.2%. Conclusion: From our study, we can conclude that CRP may be used as an initial investigation to decide use of appropriate antibiotics in acute exacerbation of COPD and avoid indiscriminate use of antibiotics.  

Keyword : AECOPD, CRP