Identifying viral infections in vaccinated Chronic Obstructive Pulmonary Disease (COPD) patients using clinical features and inflammatory markers

Abstract

Background Known inflammatory markers have limited sensitivity and specificity to differentiate viral respiratory tract infections from other causes of acute exacerbation of COPD (AECOPD). To overcome this, we developed a multi‐factorial prediction model combining viral symptoms with inflammatory markers. Methods Interleukin‐6 (IL‐6), serum amyloid A (SAA) and viral symptoms were measured in stable COPD and at AECOPD onset and compared with the viral detection rates on multiplex PCR. The predictive accuracy of each measure was assessed using logistic regression and receiver operating characteristics curve (ROC) analysis. Results There was a total of 33 viruses detected at the onset of 148 AECOPD, the majority 26 (79%) were picornavirus. Viral symptoms with the highest predictive values were rhinorrhoea [Odds ratio (OR) 4·52; 95% CI 1·99–10·29; P < 0·001] and sore throat (OR 2·64; 95% CI 1·14–6·08; P = 0·022), combined the AUC ROC curve was 0·67. At AECOPD onset patients experienced a 1·6‐fold increase in IL‐6 (P = 0·008) and 4·5‐fold increase in SAA (P < 0·001). The addition of IL‐6 to the above model significantly improved diagnostic accuracy compared with symptoms alone (AUC ROC 0·80 (P = 0·012). Conclusion The addition of inflammatory markers increases the specificity of a clinical case definition for viral infection, particularly picornavirus infection.

The Expression of IL-6, TNF-α, and MCP-1 in Respiratory Viral Infection in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

“…Fever and sore throat were the two major symptoms which differentiated viral AECOPD from nonviral AECOPD ( Table 3 ), which suggests that the diagnosis of viral symptoms may be the elementary step to accurate case-definition of viral AECOPD. The combination of clinical symptoms with measurement of inflammatory marker levels markedly increased the predictive accuracy compared with the diagnosis of clinical features alone [ 26 ].…”

Bronchiectasis exacerbation study on azithromycin and amoxycillin-clavulanate for respiratory exacerbations in children (BEST-2): study protocol for a randomized controlled trial

“…In asthma [61], CF [74] and COPD [75,76], viral triggers of acute exacerbations are well described; however, no such data exist for non-CF bronchiectasis. Whether other potential respiratory pathogens ( M. pneumoniae and Chlamydiales species) trigger exacerbations is also unknown.…”

The influence of virus infections on the course of COPD

“…In fact, they represent the most common infectious cause of chronic obstructive pulmonary disease exacerbations [68,69]. Viral symptoms with high predictive value in COPD patients with picornavirus infection include rhinorrhea, sore-throat, and discrete IL-6 increase [70]. Cough is usually associated with increased production of neuropeptides and leukotrienes, altered expression of neural receptors, and increased airway mucus production [71].…”