EVALUATION OF SYSTEMIC INFLAMMATORY MARKERS IN COPD PATIENTS DURING STABLE AND EXACERBATION PHASES
DOI:
https://doi.org/10.53350/Annalspakmed.1.6.18Keywords:
Chronic obstructive pulmonary disease, systemic inflammation, CRP, IL-6, TNF-α, exacerbation phase, cytokinesAbstract
Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive inflammatory disorder characterized by irreversible airflow limitation and recurrent exacerbations that accelerate morbidity and mortality. Systemic inflammation plays a crucial role in disease progression, yet variations in inflammatory marker levels during stable and exacerbation phases remain under-evaluated in regional populations.
Objective: To assess and compare systemic inflammatory markers—C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α)—in COPD patients during stable and exacerbation phases and determine their clinical significance.
Methods: This cross-sectional study was conducted across tertiary care centers in Punjab, Pakistan, from January 2024 to December 2024. A total of 100 spirometry-confirmed COPD patients were enrolled, equally divided into stable and exacerbation groups. Venous blood samples were collected for quantitative estimation of CRP, IL-6, and TNF-α using high-sensitivity immunoturbidimetric and ELISA assays. Data were analyzed using SPSS v26, and p < 0.05 was considered statistically significant.
Results: Mean serum CRP, IL-6, and TNF-α levels were significantly higher during exacerbation (27.9 ± 7.8 mg/L, 12.2 ± 3.5 pg/mL, and 18.7 ± 4.9 pg/mL, respectively) compared with the stable phase (8.6 ± 3.4 mg/L, 4.1 ± 1.6 pg/mL, and 9.4 ± 3.1 pg/mL; p < 0.001). A strong positive correlation was observed between IL-6 and TNF-α (r = 0.79) during exacerbations, indicating synergistic cytokine activation.
Conclusion: Systemic inflammation markedly intensifies during COPD exacerbations, with CRP, IL-6, and TNF-α serving as reliable biomarkers for disease monitoring. Regular assessment of these markers may enhance early detection, therapeutic optimization, and prevention of recurrent exacerbations.
References
1. Agustí A, Hogg JC. Update on the pathogenesis of chronic obstructive pulmonary disease. N Engl J Med. 2019;381(13):1248–1256. doi:10.1056/NEJMra1900475
2. De Torres JP, Cordoba-Lanus E, Lopez-Aguilar C, et al. C-reactive protein levels and clinical outcomes in stable and exacerbated COPD. Chest. 2016;150(5):1033–1042. doi:10.1016/j.chest.2016.06.017
3. Barnes PJ. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2016;138(1):16–27. doi:10.1016/j.jaci.2016.05.011
4. Singh D, Agusti A, Anzueto A, et al. Inflammatory biomarkers in chronic obstructive pulmonary disease: insights and perspectives. Respir Res. 2019;20(1):228. doi:10.1186/s12931-019-1212-5
5. Wouters EFM, Reynaert NL, Dentener MA, Vernooy JH. Systemic and local inflammation in asthma and chronic obstructive pulmonary disease: is there a connection? Proc Am Thorac Soc. 2017;14(3):406–415. doi:10.1513/pats.201606-047AW
6. Pinto-Plata VM, Mullerova H, Toso JF, et al. Systemic cytokines and chronic obstructive pulmonary disease exacerbations. Chest. 2017;152(6):1291–1300. doi:10.1016/j.chest.2017.08.024
7. Divo M, Cote C, de Torres JP, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2020;201(2):148–155. doi:10.1164/rccm.201911-2055OC
8. Rahman I, Adcock IM. Oxidative stress and cytokine signaling in chronic obstructive pulmonary disease. Trends Pharmacol Sci. 2018;39(7):634–648. doi:10.1016/j.tips.2018.04.005
9. Celli BR, Wedzicha JA. Update on clinical aspects of chronic obstructive pulmonary disease exacerbations. N Engl J Med. 2019;381(13):1257–1266. doi:10.1056/NEJMra1900476
10. Chen W, Thomas J, Sadatsafavi M, FitzGerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(8):631–639. doi:10.1016/S2213-2600(15)00241-6
11. Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2015;385(9971):725–735. doi:10.1016/S0140-6736(14)62409-7
12. Kim V, Rogers TJ, Criner GJ. New concepts in the pathobiology of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2017;14(4):407–415. doi:10.1513/pats.201612-247AW
13. Fabbri LM, Beghe B, Agustí A. Cardiovascular mechanisms in COPD. Eur Respir J. 2019;54(1):1900879. doi:10.1183/13993003.00879-2019
14. Brusse-Keizer MGJ, Groenen MTJ, Soeters PB, et al. Systemic inflammation in COPD patients remains active after smoking cessation. Respir Med. 2016;112:72–79. doi:10.1016/j.rmed.2016.01.014
15. Tan KS, Lim RL, Liu J, Ong HH, Tan JL, Tan BH. Elevated systemic inflammatory cytokines in COPD exacerbations and recovery. Int J Chron Obstruct Pulmon Dis. 2017;12:3009–3017. doi:10.2147/COPD.S144156
16. Joppa P, Petrasova D, Stancak B, Tkacova R. C-reactive protein levels in patients with COPD: relation to lung function and systemic inflammation. Eur J Med Res. 2015;20(1):32. doi:10.1186/s40001-015-0118-2
17. Han MK, Quibrera PM, Carretta EE, et al. Frequency of exacerbations in chronic obstructive pulmonary disease: an analysis of the SPIROMICS cohort. Lancet Respir Med. 2017;5(8):619–626. doi:10.1016/S2213-2600(17)30207-0
18. Su B, Liu T, Fan H, et al. Inflammatory markers and COPD: systematic review and meta-analysis. PLoS One. 2016;11(6):e0157652. doi:10.1371/journal.pone.0157652
19. Huang J, Zhang J, Zheng Y, et al. Relationship of serum TNF-α, IL-6, and CRP with COPD severity and acute exacerbations. Int J Chron Obstruct Pulmon Dis. 2021;16:1203–1212. doi:10.2147/COPD.S302446
20. Li J, Zhao X, Qiu J, et al. Circulating cytokines and systemic inflammation in chronic obstructive pulmonary disease: biomarkers for disease activity and severity. Front Immunol. 2023;14:1134405. doi:10.3389/fimmu.2023.1134405
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 SHAHZAD SHOUKAT, BILAL RAFIQUE MALIK, SHAHID IQBAL
This work is licensed under a Creative Commons Attribution 4.0 International License.
