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• W2807682791 abstract "INTRODUCTION:Systemic inflammation is increasingly being recognized as a risk factorfor a number of different complications including atherosclerosis1 cachexia,anorexia, and osteoporosis. Notably, all of these complications are commonlyobserved in patients with chronic obstructive pulmonary disease (COPD).Chronic obstructive pulmonary disease (COPD) is characterized by airwayinflammation which is considered to play a pathogenic role in this disorder. Anincrease in both bronchial and systemic inflammation has also beendemonstrated. Whether systemic inflammation is present in stable COPD andwhether it is wholly or partially responsible for these associations iscontroversial. Although several studies have been undertaken to evaluate thispotential relationship, most of the studies have been conducted duringexacerbations of copd and among western population. We wanted to study thecorrelation of levels of hs-crp and plasma fibrinogen with increasing severity ofCOPD among Indian patients presenting to OPD in GGH, MMC, CHENNAI.We choose these markers of systemic inflammation because they have been well studied and have been intimately linked with the development of ischaemic heart disease and stroke which, interestingly, are also the leading causes of mortality among patients with COPD. There is evidence to suggest an imbalance in systemic levels of pro- and anti-inflammatory mediators in patients with stableCOPD. The presence of these proinflammatory markers in increased levels inpatients with COPD in both stable state and during exacerrebration mightpredispose them to adverse cardiovascular, cerebrovascular events acutelyand the presence of a chronic inflammatory state may predispose to systemiceffects such as cachexia, decreased bone mineral density with attendant risk offracture, renal dysfunction, accelerated atherosclerosis, malignancy and anaemia.The treatment of this chronic inflammatory state and the early treatment of acuteexacerrebration with conventional and possible newer therapeutic targets couldpossibly lead to lower incidence of these systemic effects and organ damage inthis population. Also the role of prophylactic against these systemic and specificorgan damage may be valuable intervention. This observative study was done tosee if there was significant rise in the levels of these pro inflammatory marker,i.e., hs-CRP and plasma fibrinogen (Possibly stimulated by IL-6) as well as othermarkers such as ESR, polymorph percentage of total WBC count, pack yearswith increasing levels of severity as it could possibly lead to consensus ontreatment protocols based on these levels during acute or chronic COPD.AIMS AND OBJECTIVES:The principal aims of this study were to:1. To determine the correlation of hs-CRP and plasma fibrinogen levelswith increasing severity of COPD in 80 patients presenting ourhospital in GGH, Chennai.2. To study the prevalence of the levels of various systemic markers ofinflammation i.e., ESR, hs-CRP, plasma fibrinogen, polymorphpercent of total WBC count in these patients with COPD at differentstages as per GOLD criteria and FEV1 percentage of predicted value.3. To study and observe the relationship between the distribution ofthese variables in this group and correlation with age, BMI, packyears of smoking.METHODS AND MATERIALS:A total of 80 patients of COPD coming to GGH, MMC were be screenedfor COPD by history clinical examination and PFT. Patients with featuresconsistent with copd and FEV1/ FVC ratio less than 0.7 were be chosen for thestudy. The FEV1/FVCratio, reflecting the rate of emptying of the lung, is used todefine the presence of an obstructive ventilatory defect. They were becategorized according to GOLD criteria using the percentage of predicted FEV1for severity of COPD. Their blood levels of hs-CRP and plasma fibrinogen werebe measured. The electronic super Spiro machine was used for doing pulmonaryfunction tests after giving appropriate instructions and ensuring the patient is nothaving any respiratory infection and repeated twice to measure the best possibleeffort by the patient. The hs-CRP was measured by nephalometric method usingthe turbox analyzer. Plasma fibrinogen was measured using immunoturbidimetric method Olympus AU400 analyzer. Other parameters such as BMI,ESR, polymorph percentage, pack years of smoking were recorded ofindividuals. A careful history with regard to the patients symptoms of COPD,smoking habits, cardiovascular illness, renal or liver disorders, any connectivetissue, autoimmune, vascullitic disorders, diabetes, hypertension, peripheralvascular disease was obtained.A thorough head to foot clinical examination of all the systems weredone. A routine battery of investigations to test for renal, liver function,diabetes, presence of ischaemic heart disease, or tuberculosis was done tocarefully select patients as per exclusion criteria.Research Design:This is a cross-sectional study assessing the levels of plasma fibrinogen,hs-CRP among other parameters such as ESR, polymorph percent, BMI, packyears of smoking, FEV1 percent of predicted in patients with COPD involving 80participants presenting to MMC, Government General Hospital, Chennai.Study setting:This study was done in the institute of internal medicine in Government General Hospital, MadrasMedical College, Chennai with inputs and active cooperation from thedepartment of thoracic medicine. Government General Hospital, MMC, Chennai.Methodology:This is a cross-sectional study conducted as described above on patientsin the age group 20-60 years. Patients, after informed consent were recruitedinto study, if they were eligible as per the criteria below.Inclusion criteria:Patients attending OPD and admitted to Medical Department in theGovernment General Hospital with clinical features of COPD, i.e.; cough withexpectoration, dyspnea, wheeze and FEV1/FVC ratio of less than 0.7 showingobstructive features on electronic Spirometry and without any comorbid illnessare selected for the study.Exclusion criteria:1. Patients who are terminally ill, critically or acutely,2. Age 60 yrs,3. Diabetics, hypertensive, past history of M.I, Stroke, TIA,4. Any arterial or venous thrombosis, peripheral vascular disease,5. H/o of immunological disorders like rheumatoid arthritis, SLE,ankylosing spondillitis.6. H/o cancer, renal disease, liver disorder,7. Ongoing infections.OBSERVATION AND RESULTS:THE study was done on 80 patients presenting to the medical departmentand were selected randomly as per the inclusion criteria and exclusion criteria.All individual patients were informed of the study and their consent wasobtained. Pulmonary function tests were done in these patient after excluding theconditions listed in the exclusion criteria with careful clinical history and simpletests such as RFT, LFT, complete blood counts, ECG,CXR, ECHO, etc. PFTwas done in the department of thoracic medicine using the electronic super Spiromachine and the patients individual FEV1, FVC, FEVI percentage of predictedvalue, FEV1/FVC was calculated and they were staged according to GOLDstage of COPD. STAGE 4 diseases was excluded.STASTISTICAL ANALYSIS:Data analysis was done with use of SPSS, version 10. Descriptivestatistics were used to calculate the frequency, mean, and standard deviation. Toexamine the linear trend of the proportions, trend chi-square was used and tofind the test of association chi-square was computed. The correlation ofvariables i.e., age ,BMI, ESR, polymorph percent of total count, hs- CRP,plasma fibrinogen with severity of COPD as per GOLD stage was analyzed withchi-square test using the Pearson method. The correlation between pack yearswith GOLD stage was analyzed using the anova test followed by the tukey- hsdtest. The correlation between the variables i.e., age ,BMI, ESR, polymorphpercent of total count, hs- CRP, plasma fibrinogen with FEV1 percentage ofpredicted values was analyzed using correlation coefficients. The correlationbetween the variables i.e., age ,BMI, ESR, polymorph percent of total count, hs-CRP, plasma fibrinogen and FEV1 percentage of predicted values with packyears of smoking was analyzed using correlation coefficients.CONCLUSIONS:1. hs-CRP has been found to be significantly elevated with increasingseverity of COPD which could lead to increased predisposition to cardiovascular morbidity and mortality.2. Plasma Fibrinogen levels were not found to be significant marker ofCOPD coagulopathy in our study or stable COPD. More studies areneeded.3. Polymorph percentages, ESR are not significant markers of inflammationin COPD.4. ESR, hs-CRP, Plasma Fibrinogen are markers of increasing exposure tosmoking.5. Physicians need to approach COPD as a multi system disease and identifypatients with the associated co-morbidities of COPD vis-a-vis the extrapulmonary manifestations of COPD." @default.
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• W2807682791 date "2010-03-01" @default.
• W2807682791 modified "2023-09-27" @default.
• W2807682791 title "Correlation of Levels of hs-CRP and Plasma Fibrinogen with increasing Severity of COPD" @default.
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