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Upper-respiratory viral infection, biomarkers, and COPD exacerbations

Published in Chest. 2010, vol. 138, no. 4, p. 896-904
Abstract BACKGROUND: Respiratory viruses frequently are recovered in the upper-respiratory tract during acute exacerbations of COPD (AECOPD), but their role as contributing pathogens remains unclear. The usefulness of procalcitonin and C-reactive protein as indicators of the presence or absence of viral infection in this setting also needs to be evaluated. METHODS: The study was of a prospective cohort of patients with COPD admitted to the ED for AECOPD. Reverse transcriptase-polymerase chain reaction (RT-PCR) for 14 respiratory viruses was performed on nasopharyngeal swabs collected at admission and after recovery in stable condition. RESULTS: Eighty-six patients (mean age, 72 years; male, 64%) were included. During AECOPD, upper-respiratory viral infections were detected in 44 (51%) patients: picornavirus in 22, metapneumovirus in seven, coronavirus in eight, influenza A/B in two, parainfluenza in two, and respiratory syncytial virus in three. A dual infection was present in three patients. After recovery, viruses were detected in only eight (11%) of 71 patients (P < .001 compared with AECOPD phase). In five of these patients, no virus had been identified during the initial exacerbation, thus suggesting a new viral infection acquired during follow-up. During AECOPD, procalcitonin and C-reactive protein levels did not differ significantly between patients with or without a proven viral infection. CONCLUSIONS: Prevalence of upper-respiratory viral infection, as detected from nasopharyngeal swab by RT-PCR, is high in AECOPD and low after clinical recovery, suggesting that AECOPD frequently are triggered by viral infections initiated in the upper-respiratory tract. In our study, serum procalcitonin and C-reactive protein did not discriminate virus-associated exacerbations from others. TRIAL REGISTRATION: clinicaltrials.gov; Identifier: NCT00448604.
Keywords AgedBiological Markers/metabolismC-Reactive Protein/*metabolismCalcitonin/*bloodChi-Square DistributionFemaleHumansMaleProportional Hazards ModelsProspective StudiesProtein Precursors/*bloodPulmonary Disease, Chronic Obstructive/blood/*virologyRespiratory Tract Infections/blood/*virologyReverse Transcriptase Polymerase Chain Reaction
PMID: 20435659
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Research groups Syncope (24)
Groupe Laurent Kaiser (virologie clinique) (668)
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KHERAD, Omar et al. Upper-respiratory viral infection, biomarkers, and COPD exacerbations. In: Chest, 2010, vol. 138, n° 4, p. 896-904. doi: 10.1378/chest.09-2225 https://archive-ouverte.unige.ch/unige:21043

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Deposited on : 2012-05-23

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