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Vol. 57. Issue 1.
Pages 21-27 (January 2021)
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Vol. 57. Issue 1.
Pages 21-27 (January 2021)
Original Article
DOI: 10.1016/j.arbr.2019.12.022
C-Reactive Protein Concentration in Steady-State Bronchiectasis: Prognostic Value of Future Severe Exacerbations. Data From the Spanish Registry of Bronchiectasis (RIBRON)
Concentración de la proteína C reactiva en las bronquiectasias en fase estable: valor pronóstico de futuras exacerbaciones graves. Datos del registro español de pacientes con bronquiectasias (RIBRON)
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Tomás Posadasa, Grace Osculloa, Enrique Zaldivara, Carmen Villab, Yadira Dobarganesb, Rosa Girónc, Casilda Olveirad, Luis Maíze, Marta García-Clementef, Oriol Sibilag, Rafael Golpeh, Juan Rodríguezi, Esther Barreiroj, Juan Luis Rodriguezk, Rosario Menéndeza, Concepción Pradosl, David de la Rosal, Miguel Angel Martinez-Garcíaa,
Corresponding author
mianmartinezgarcia@gmail.com

Corresponding author.
, on behalf of the Spanish Registry of Bronchiectasis Group (RIBRON)
a Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
b Respiratory Department, Clinica Fuensanta, Madrid, Spain
c Instituto de Investigación Sanitaria, Respiratory Department, Hospital Universitario de la Princesa, Madrid, Spain
d Pneumology Department, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, Spain
e Respiratory Department, Hospital Ramon and Cajal, Madrid, Spain
f Respiratory Department, Hospital Universitario Central de Asturias, Oviedo, Spain
g Pneumology Department, Hospital Clínic Barcelona, Spain
h Respiratory Department, Hospital Lucus Augusti, Lugo, Spain
i Respiratory Department, Hospital San Agustin, Avilés, Spain
j Respiratory Department, Hospital del Mar-IMIM, UPF, CIBERES, Spain
k Respiratory Department, Hospital San Carlos, Madrid, Spain
l Respiratory Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
SPANISH REGISTRY OF BRONCHIECTASIS GROUP
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Tables (5)
Table 1. Baseline Values of the Patients Finally Included in the Study.
Table 2. Comparative Characteristic of the Included Patients Depending on the CRP Concentration.
Table 3. Risk Factors for the Presence of at Least One Severe Exacerbation in the First Year of the Follow-up.
Table 4. Risk Factors for the Presence of at Least Two Mild or Moderate Exacerbations in the First Year of the Follow-up.
Table 5. Prognostic Values for at Least One Severe Exacerbation in the First Year of Follow-up of the Levels of CRP, According to the Various Scales of Bronchiectasis Severity.
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Abstract
Background

Both systemic inflammation and exacerbations have been associated with greater severity of bronchiectasis. Our objective was to analyze the prognostic value of the peripheral concentration of C-reactive protein (CRP) for the number and severity of exacerbations in patients with bronchiectasis.

Methods

Patients from the Spanish Bronchiectasis Registry (RIBRON) with valid data on their CRP value (in a clinically stable phase) and valid data on exacerbations during the first year of follow-up were included. A logistic regression analysis was used to evaluate the prognostic value of the CRP concentration (divided into tertiles) with the presence of at least one severe exacerbation or at least two mild-moderate exacerbations during the first year of follow-up.

Results

802 patients (mean age: 68.1 [11.1 years], 65% female) were included. Of these, 33.8% and 13%, respectively, presented ≥2 mild-moderate exacerbations or at least one severe exacerbation during the first year of follow-up. The mean value of the CRP was 6.5 (17.6mg/L). Patients with a CRP value between 0.4 and 2.7mg/L (second tertile) and ≥2.7mg/L (third tertile) presented a 2.9 (95%CI: 1.4–5.9) and 4.2 (95%CI: 2.2–8.2) times greater probability, respectively, of experiencing a severe exacerbation than those with <0.4mg/L (control group), regardless of bronchiectasis severity or a history of previous exacerbations. However, the CRP value did not present any prognostic value for the number of mild-moderate exacerbations.

Conclusions

The CRP value was associated with a greater risk of future severe exacerbations but not with mild or moderate exacerbations in patients with steady-state bronchiectasis.

Keywords:
Bronchiectasis
C-reactive protein
Exacerbation
Hospitalization
Pseudomonas aeruginosa
Resumen
Contexto general

Tanto la inflamación sistémica como las exacerbaciones se han asociado con una mayor gravedad de las bronquiectasias. Nuestro objetivo fue analizar el valor de la concentración en sangre periférica de proteína C reactiva (PCR) para predecir el número y la gravedad de las exacerbaciones en pacientes con bronquiectasias.

Métodos

Se incluyeron pacientes del Registro Español de Pacientes con Bronquiectasias (RIBRON) con datos válidos sobre sus niveles de PCR (en fase clínicamente estable) y datos válidos sobre exacerbaciones durante el primer año de seguimiento. Se utilizó un análisis de regresión logística para evaluar el valor pronóstico de la concentración de PCR (dividida en terciles) con la presencia de al menos una exacerbación grave o al menos dos exacerbaciones leves-moderadas durante el primer año de seguimiento.

Resultados

Se incluyeron 802 pacientes (edad media: 68,1 [11,1] años, 65% mujeres). De ellos, el 33,8% y el 13%, respectivamente, presentaron ≥2 exacerbaciones leves-moderadas o al menos una exacerbación grave durante el primer año de seguimiento. El valor medio de la PCR fue de 6,5 (17,6) mg/L. Los pacientes con un valor de PCR entre 0,4 y 2,7mg/L (segundo tercil) y ≥2,7mg/L (tercer tercil) presentaron 2,9 veces (IC 95%: 1,4-5,9) y 4,2 veces (IC 95%: 2,2-8,2) más probabilidad, respectivamente, de experimentar una exacerbación grave que aquellos con <0,4mg/L (grupo de control), independientemente de la gravedad de las bronquiectasias o de presentar antecedentes de exacerbaciones previas. Sin embargo, el valor de la PCR no presentó ninguna utilidad pronóstica para el número de exacerbaciones leves-moderadas.

Conclusiones

El valor de la PCR se asoció a un mayor riesgo de exacerbaciones graves en el futuro, pero no a las exacerbaciones leves o moderadas en pacientes con bronquiectasias en fase estable.

Palabras clave:
Bronquiectasias
Proteína C reactiva
Exacerbación
Hospitalización
Pseudomonas aeruginosa

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