C-Reactive Protein in Stable Cystic Fibrosis: An Additional Indicator of Clinical Disease Activity and Risk of Future Pulmonary Exacerbations
Elias Matouk1,3,4*, Dao Nguyen3,4,6, Andrea Benedetti3,4,5, Joanie Bernier1, James Gruber1,4, Jennifer Landry1,3,4, Simon Rousseau4,6, Heather G Ahlgren3,4, Larry C Lands3,6,7, Gabriella Wojewodka2,3,4 and Danuta Radzioch2,3,4
- *Corresponding Author:
- Elias Matouk
Adult Cystic Fibrosis Clinic, Montreal Chest Institute
McGill University, Canada
Tel: +1 514 826 0765
E-mail: [email protected]
Received date: September 13, 2016; Accepted date: October 20, 2016; Published date: October 24, 2016
Citation: Matouk E, Nguyen D, Benedetti A, Bernier J, Gruber J, et al. (2016) C-Reactive Protein in Stable Cystic Fibrosis: An Additional Indicator of Clinical Disease Activity and Risk of Future Pulmonary Exacerbations. J Pulm Respir Med 6:375. doi: 10.4172/2161-105X.1000375
Copyright: © 2016 Matouk E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction: In stable adult cystic fibrosis (CF) patients, we assessed the role of baseline high sensitivity C-reactive protein (hs-CRP) on CF clinical variables and frequency of intravenous (IV) treated pulmonary exacerbations (PExs) 1-year post- baseline. Methods: We recruited 51 clinically stable CF patients from our Adult CF Center. We incorporated collected parameters into Matouk CF clinical score and CF questionnaire-revised quality of life score (QOL). We used the clinical minus complications subscores as a clinical disease activity score (CDAS). We dichotomized our patients according to the cohort median baseline hs-CRP of 5.2 mg/L. Results: Patients in the high hs-CRP group (≥ 5.2 mg/L) demonstrated worse CDAS (r=0.67, p=0.0001) and QOL scores (r=0.57, p=0.0017) at a given FEV1 % predicted. In both hs-CRP groups, prior-year IV-treated PExs and baseline CDASs were significant predictors of future IV-treated PExs. Interestingly, the association between baseline CDAS and future PExs frequency was more robust in the high compared to the low hs-CRP group (r=–0.88, p<0.0001, r=–0.48, p=0.017, respectively) with a steeper regression slope (p=0.001). In addition, a significant interaction was demonstrated between elevated baseline hs-CRP levels and CDASs for the prediction of increased risk of future PExs (p=0.02). This interaction provided an additional indicator of clinical disease activity and added another dimension to the prior year PExs frequency phenotype to identify patients at increased risk for future PExs. Conclusion: Stable CF patients with elevated baseline hs-CRP (≥ 5.2 mg/L) demonstrated worse clinical disease activity and QOL scores at a given level of disease severity (FEV1 % predicted). Elevated baseline hs-CRP values combined with clinical disease activity scores are associated with increased risk for future IV-treated PExs even in those with mild clinical disease activity scores.