Case Western Reserve Univ. School of Medicine, Cleveland OH, USA.
Univ. of Washington, Seattle WA, USA; CFF TDNCC, Seattle Children's Hospital, Seattle WA, USA.
J Cyst Fibros. 2022 Jul;21(4):588-593. doi: 10.1016/j.jcf.2021.12.003. Epub 2021 Dec 18.
C-reactive protein (CRP) has been proposed as a biomarker for pulmonary exacerbation (PEx) diagnosis and treatment response. CRP >75mg/L has been associated with increased risk of PEx treatment failure. We have analyzed CRP measures as biomarkers for clinical response during the STOP2 PEx study (NCT02781610).
CRP measures were collected at antimicrobial treatment start (V1), seven to 10 days later (V2), and two weeks after treatment end (V3). V1 logCRP concentrations and logCRP change from V1 to V3 correlations with clinical responses (changes in lung function and symptom score) were assessed by least squares regression. Odds of intravenous (IV) antimicrobial retreatment within 30 days and future PEx hazard associated with V1 and V3 CRP concentrations and V1 CRP >75 mg/L were studied by adjusted logistic regression and proportional hazards modeling, respectively.
In all, 951 of 982 STOP2 subjects (92.7%) had CRP measures at V1. V1 logCRP varied significantly by V1 lung function subgroup, symptom score quartile, and sex, but not by age subgroup. V1 logCRP correlated moderately with logCRP change at V3 (r=0.255) but less so with lung function (r=0.016) or symptom (r=0.031) changes at V3. Higher V1 CRP was associated with greater response. CRP changes from V1 to V3 only weakly correlated with lung function (r=0.061) and symptom (r=0.066) changes. However, V3 logCRP was associated with increased odds of retreatment (P = .0081) and future PEx hazard (P = .0114).
Despite consistent trends, logCRP change was highly variable with only limited utility as a biomarker of PEx treatment response.
C 反应蛋白（CRP）已被提议作为诊断和治疗反应的生物标志物。CRP＞75mg/L 与 PEx 治疗失败的风险增加有关。我们已经分析了 CRP 指标在 STOP2 PEx 研究（NCT02781610）中的临床反应中的生物标志物作用。
在开始抗菌治疗时（V1）、7-10 天后（V2）和治疗结束后两周（V3）收集 CRP 测量值。通过最小二乘回归评估 V1 logCRP 浓度和 V1 到 V3 的 logCRP 变化与临床反应（肺功能和症状评分的变化）之间的相关性。通过调整后的逻辑回归和比例风险模型分别研究了 30 天内静脉（IV）抗菌药物再治疗的可能性和与 V1 和 V3 CRP 浓度以及 V1 CRP＞75mg/L 相关的未来 PEx 风险。
在所有 982 名 STOP2 受试者中，有 951 名（92.7%）在 V1 时有 CRP 测量值。V1 logCRP 在 V1 肺功能亚组、症状评分四分位数和性别之间存在显著差异，但在年龄亚组之间没有差异。V1 logCRP 与 V3 的 logCRP 变化中度相关（r=0.255），但与 V3 的肺功能（r=0.016）或症状（r=0.031）变化相关性较差。较高的 V1 CRP 与更大的反应相关。V1 到 V3 的 CRP 变化与肺功能（r=0.061）和症状（r=0.066）变化仅弱相关。然而，V3 logCRP 与再治疗的可能性增加（P=0.0081）和未来 PEx 风险（P=0.0114）相关。
尽管存在一致的趋势，但 logCRP 变化变化很大，作为 PEx 治疗反应的生物标志物仅有有限的效用。
