Search

Background: Extracellular matrix (ECM) remodeling of the lung tissue releases protein fragments into the blood, where they may be detected as serologic surrogate markers of disease activity in COPD. Our goal was to assess the association of ECM turnover with severity and outcome of COPD.Methods: In a prospective, observational, multicenter study including 506 patients with COPD (Global Initiative for Chronic Obstructive Lung Disease grades II to IV), serum samples were analyzed at stable state, exacerbation, and 4 weeks after exacerbation. The analysis comprised a panel of five novel neoepitopes, including fragments of collagen type III (C3M) and collagen type VI (C6M), pro-forms of collagen type III (Pro-C3) and type VI (Pro-C6), and neutrophil elastase-generated fragments of elastin (EL-NE) according to enzyme-linked immunosorbent assay. These neoepitopes were also measured at stable state in a derivation cohort that included 100 patients with COPD.Results: Serum levels of C3M, C6M, Pro-C3, Pro-C6, and EL-NE were associated with lung function. Patients with the lowest levels of Pro-C3 and Pro-C6 had more severe airflow limitation, hyperinflation, air trapping, and emphysema. C3M and C6M were associated with dyspnea. All ECM biomarkers, except Pro-C6, were increased at exacerbation compared with stable state but, except EL-NE, did not differ between stable state and exacerbation follow-up in the crude and adjusted analyses. In Cox regression adjusted analyses, Pro-C3 was associated with a shorter time to exacerbation (hazard ratio, 0.72; CI, 0.59-0.89; P = .002) and Pro-C6 with survival (hazard ratio, 2.09; CI, 1.18-3.71; P = .011).Conclusions: Serum biomarkers of ECM turnover were significantly associated with disease severity and clinically relevant outcomes in patients with COPD.Trial Registry: No.: ISRCTN99586989; URL: www.controlled-trials.com. [ABSTRACT FROM AUTHOR]

Study objectives: Evaluation of a newly available rapid (15 min) immunochromatographic membrane test (ICT) to detect Streptococcus pneumoniae in urine samples, in order to assess its utility in the diagnosis of bacteremic and nonbacteremic pneumococcal pneumonia. Design: Retrospective study. Setting: We studied urine samples from 51 patients with bacteremic and nonbacteremic pneumonia due to S pneumoniae diagnosed by blood culture and pneumococcal polysaccharide capsular antigen detection by counterimmunoelectrophoresis in urine samples, 16 patients with probable pneumococcal pneumonia, 71 patients with nonpneumococcal pneumonia, and 16 patients with pneumonia but no pathogen identified. Urine samples were collected and frozen at -20°C until used. The ICT test was performed following the instructions of the manufacturer. Measurements and results: S pneumoniae antigen was detected in 41 of 51 patients with pneumococcal pneumonia (80.4%); results were positive in 23 of 28 bacteremic cases (82.1%) and in 18 of 23 nonbacteremic cases (78.3%). From patients with a diagnosis of presumptive pneumococcal pneumonia, antigen was detected in seven urine samples (43.7%) and also in one case of the 16 patients with pneumonia but no pathogen identified. The specificity of the ICT test was 97.2%. Conclusion: The ICT assay is a valuable tool for the diagnosis of pneumococcal pneumonia, especially for the nonbacteremic cases. [ABSTRACT FROM AUTHOR]

Comments on an article evaluating an immunochromatographic membrane test to detect Streptococcus pneumoniae in urine samples, published in a previous issue of 'Chest.' Performance of the test; Low sensitivity and specificity of the techniques.