Inflammatory biomarkers improve clinical prediction of mortality in chronic obstructive pulmonary disease

Bartolome R. Celli, Nicholas Locantore, Julie Yates, Ruth Tal-Singer, Bruce E. Miller, Per Bakke, Peter Calverley, Harvey Coxson, Courtney Crim, Lisa D. Edwards, David A. Lomas, Annelyse Duvoix, William MacNee, Stephen Rennard, Edwin Silverman, Jørgen Vestbo, Emiel Wouters, Alvar Agustí

Research output: Contribution to journalArticlepeer-review

327 Scopus citations


Rationale: Accurate prediction of mortality helps select patients for interventions aimed at improving outcome. Objectives: Because chronic obstructive pulmonary disease is characterized by low-grade systemic inflammation, we hypothesized that addition of inflammatory biomarkers to established predictive factors will improve accuracy. Methods: A total of 1,843 patients enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study were followed for 3 years. Kaplan-Meier curves, log-rank analysis, and Cox proportional hazards analyses determined the predictive value for mortality of clinical variables, while C statistics assessed the added discriminative power offered by addition of biomarkers. Measurements and Main Results: At recruitment we measured anthropometrics, spirometry, 6-minute walk distance, dyspnea, BODE index, history of hospitalization, comorbidities, and computed tomography scan emphysema. White blood cell and neutrophil counts, serum or plasma levels of fibrinogen, chemokine ligand 18, surfactant protein D, C-reactive protein, Clara cell secretory protein-16, IL-6 and -8, and tumor necrosis factor-α were determined at recruitment and subsequent visits. A total of 168 of the 1,843 patients (9.1%) died. Non-survivors were older and hadmore severe airflow limitation, increased dyspnea, higher BODE score, more emphysema, and higher rates of comorbidities and history of hospitalizations. The best predictive model for mortality using clinical variables included age, BODE, and hospitalization history (C statistic of 0.686; P < 0.001). One single biomarker (IL-6) significantly improved the C statistic to 0.708, but this was further improved to 0.726 (P = 0.003) by the addition of all biomarkers. Conclusions: The addition of a panel of selected biomarkers improves the ability of established clinical variables to predict mortality in chronic obstructive pulmonary disease. Clinical trial registered with (NCT00292552).

Original languageEnglish (US)
Pages (from-to)1065-1072
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number10
StatePublished - May 15 2012


  • Biologic markers
  • Mortality
  • Prognosis
  • Pulmonary disease, chronic obstructive

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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