Elevated placenta growth factor predicts pneumonia in patients with chronic obstructive pulmonary disease under inhaled corticosteroids therapyReportar como inadecuado

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BMC Pulmonary Medicine

, 11:46

First Online: 30 September 2011Received: 10 March 2011Accepted: 30 September 2011


BackgroundAn increased incidence of pneumonia in patients with chronic obstructive pulmonary disease COPD under inhaled corticosteroid ICS therapy was noticed in previous studies. We performed a prospective study to elucidate the risk factors for the development of pneumonia in this group of patients.

MethodsA prospective, non-randomized study with patients diagnosed as having COPD from 2007 to 2008 identified in the Far Eastern Memorial Hospital were recruited. We recorded data for all patients, including clinical features and signs, demographic data, lung function status, and medications. Bio-markers such as C-reactive protein CRP and placenta growth factor PlGF were checked at first diagnosis. Every acute exacerbation was also recorded, especially pneumonia events, which were confirmed by chest radiography. Multivariate analysis was performed with stepwise logistic regression for pneumonia risk factors.

Results274 patients were diagnosed as having COPD during the study period and 29 patients suffered from pneumonia with a prevalence of 10.6%. The rate was significantly higher in patients with ICS therapy 20-125, 16% compared with those without ICS 9-149, 6% p = 0.02. We stratified ICS therapy into medium dose 500-999 ug-day fluticasone equivalent, 71 patients and high dose 1000 ug-day and higher fluticasone equivalent, 54 patients group. There was no statistical difference in the incidence of pneumonia between these two group medium dose: 13-71, 18.3% vs. high dose: 7-54, 12.9%, p = 0.47. Multivariate analysis was performed to identify the risk factors for developing pneumonia and included forced expiratory volume in one second FEV1 less than 40% of predicted odds ratio OR 2.2, 95% confidence interval CI: 1.1-6.9, ICS prescription OR 2.4, 95% CI: 1.3-8.7, the presence of diabetes mellitus DM OR 2.6, 95% CI: 1.2-9.4 and PlGF level over 40 pg-L OR 4.1, 95% CI: 1.5-9.9.

ConclusionICS therapy in patients with COPD increased the risk of pneumonia. However, there was no relationship between the incidence of pneumonia and dosage of ICS. Additionally, advanced COPD status, DM and elevated PlGF level were independent risk factors for the development of pneumonia. PlGF would be a good novel biomarker for predicting pneumonia.

Keywordschronic obstructive pulmonary disease placenta growth factor inhaled corticosteroids  Download fulltext PDF

Autor: Shih-Lung Cheng - Hao-Chien Wang - Shih-Jung Cheng - Chong-Jen Yu

Fuente: https://link.springer.com/

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