Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, The Netherlands.
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
Chest. 2018 Jul;154(1):51-57. doi: 10.1016/j.chest.2018.02.006. Epub 2018 Feb 21.
Elevated levels of midrange proadrenomedullin (MR-proADM) are associated with worse outcome in different diseases, including COPD. The association of stable-state MR-proADM with severe acute exacerbations of COPD (AECOPDs) requiring hospitalization, or with community-acquired pneumonia (CAP) in patients with COPD, has not been studied yet. The aim of this study was to evaluate the association of stable-state MR-proADM with severe AECOPD and CAP in patients with COPD.
This study pooled data of 1,285 patients from the Cohort of Mortality and Inflammation in COPD (COMIC) and PRedicting Outcome using systemic Markers In Severe Exacerbations of Chronic Obstructive Pulmonary Disease (PROMISE-COPD) cohort studies. Time until first severe AECOPD was compared between patients with high (≥ 0.87 nmol/L) or low (< 0.87 nmol/L) levels of plasma MR-proADM in stable state as previously defined. For time until first CAP, only COMIC data (n = 795) were available.
Patients with COPD with high-level stable-state MR-proADM have a significantly higher risk for severe AECOPD compared with those with low-level MR-proADM with a corrected hazard ratio (HR) of 1.30 (95% CI, 1.01-1.68). Patients with high-level stable-state MR-proADM had a significantly higher risk for CAP compared with patients with COPD with low-level MR-proADM in univariate analysis (HR, 1.93; 95% CI, 1.24-3.01), but after correction for age, lung function, and previous AECOPD, the association was no longer significant (corrected HR, 1.10; 95% CI, 0.68-1.80).
Stable-state high-level MR-proADM in patients with COPD is associated with severe AECOPD but not with CAP.
中程前肾上腺髓质素（MR-proADM）水平升高与包括 COPD 在内的不同疾病的不良预后相关。稳定状态下的 MR-proADM 与需要住院治疗的 COPD 严重急性加重（AECOPD）或合并 COPD 的社区获得性肺炎（CAP）之间的关联尚未得到研究。本研究旨在评估稳定状态下的 MR-proADM 与 COPD 患者的严重 AECOPD 和 CAP 的相关性。
本研究汇总了来自 COPD 死亡率和炎症队列研究（COMIC）和预测严重 COPD 急性加重期系统标志物预后（PROMISE-COPD）队列研究的 1285 名患者的数据。根据先前定义的稳定状态下的血浆 MR-proADM 水平（高：≥0.87nmol/L；低：<0.87nmol/L），比较患者间首次严重 AECOPD 的时间。对于首次 CAP 的时间，仅 COMIC 数据（n=795）可用。
与低水平 MR-proADM 患者相比，高水平稳定状态下的 MR-proADM 患者发生严重 AECOPD 的风险显著更高，校正后的危险比（HR）为 1.30（95%可信区间，1.01-1.68）。在单变量分析中，高水平稳定状态下的 MR-proADM 患者发生 CAP 的风险明显高于低水平 MR-proADM 患者（HR，1.93；95%可信区间，1.24-3.01），但在校正年龄、肺功能和既往 AECOPD 后，这种相关性不再显著（校正 HR，1.10；95%可信区间，0.68-1.80）。
COPD 患者稳定状态下高水平的 MR-proADM 与严重 AECOPD 相关，但与 CAP 无关。
