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C-Reactive Protein Changes in Adult and Pediatric People With Cystic Fibrosis During Treatment of Pulmonary
Jonathan B Zuckerman1, Alexandra C Hinton2, Thomas Lahiri3
1Maine Medical Center, Division of Pulmonary and Critical Care, Portland, Maine, USA.
Insights
C-reactive protein (CRP) levels are elevated during pulmonary exacerbations (PEX) in people with cystic fibrosis (CF). CRP responses to antibiotic treatment are more pronounced in adults, especially those with severe lung disease.
Area of Science:
- Biomedical Science
- Pulmonology
- Inflammation Markers
Background:
- Pulmonary exacerbations (PEX) are critical events in cystic fibrosis (CF).
- C-reactive protein (CRP) is a key inflammatory marker, but its age-specific dynamics during PEX treatment are not well understood.
- Understanding CRP profiles can inform PEX management in people with CF (PwCF).
Purpose of the Study:
- To characterize age-related C-reactive protein (CRP) profiles in pediatric and adult people with cystic fibrosis (PwCF) during pulmonary exacerbations (PEX).
- To investigate the relationship between CRP levels, age, lung function, PEX symptom severity, and time to the next PEX.
Main Methods:
- Measured CRP concentrations at the start and end of intravenous (IV) antibiotic therapy for PEX.
- Included 100 pediatric and 147 adult PwCF across 10 US CF Centers.
- Analyzed CRP correlations with age, lung function decline, symptom scores, and time to subsequent PEX.
Main Results:
- Adult PwCF had higher initial CRP levels during PEX compared to pediatric PwCF (median 8 mg/L vs. 5 mg/L).
- Initial CRP correlated with lung function decline at PEX onset in both age groups.
- CRP declined with IV antibiotic treatment more frequently and with greater variability in adults, particularly those with higher symptom burden and advanced lung disease.
Conclusions:
- C-reactive protein (CRP) increases at PEX onset and decreases with IV antibiotic treatment in children and adults with cystic fibrosis (CF).
- The CRP response to PEX treatment is more pronounced in adults, especially those with severe symptoms and advanced lung disease.
- Elevated end-of-treatment CRP in adults is linked to incomplete lung function recovery and may predict shorter time to the next PEX.
Objective:
Although studies have examined changes in C-reactive protein (CRP) during pulmonary exacerbations (PEX) in people with cystic fibrosis (PwCF), few have evaluated CRP profiles across age groups. Here, we characterize age-related CRP responses to PEX treatment.
Methods:
We measured CRP concentrations at the beginning and end of intravenous (IV) antibiotic therapy for PEX in 100 pediatric and 147 adult PwCF at 10 US CF Centers. We examined relationships between CRP and age, lung function, severity of PEX symptoms, and time to next PEX.
Results:
CRP measured at initiation of IV antibiotic treatment for PEX was higher in adults than children, median 8 mg/L (IQR 4, 32) versus 5 mg/L (IQR 2, 10), respectively (p < 0.001). There was a significant correlation between the initial CRP and drop in lung from baseline to the beginning of IV antibiotics in adults and children. Adjusted CRP dropped in response to PEX treatment more commonly in adults than in children (70% vs. 48%, respectively). The range of treatment responses was greater in adults, in those with higher symptom scores, and in those with more advanced lung disease. In adults elevated CRP at the end of treatment was also associated with incomplete recovery of lung function. CRP at the start of IV antibiotics was inversely related to time until the next PEX.
Conclusion:
In children and adults with CF, CRP is increased at the initiation of IV antibiotic therapy for PEX and declines with treatment. The response is more pronounced in highly symptomatic adults with advanced lung disease.
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