Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Dr Mohan Z Mani,
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Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : OC01 - OC05 Full Version

Role of C-reactive Protein and Mean Platelet Volume in Predicting COPD Severity and its Association with Cardiac Abnormalities among the Southern Indian Population: A Cross-sectional Study


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/62784.18059
Suresh Sagadevan, Radhika Sharma, Aruna Shanmuganathan, Meenakshi Narasimhan

1. Assistant Professor, Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India. 2. Assistant Professor, Department of Respiratory Medicine, Ayaan Institute of Medical Sciences, Moinabad, Hyderabad, India. 3. Professor, Department of Respiratory Medicine, Karpaga Vinayaga Institute of Medical Science, Chengelpet, Tamil Nadu, India. 4. Professor and Head, Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Suresh Sagadevan,
2/3 Lattur Mathura, Angamampattu, Vittilapuram Village, Kalpakkam, Chennai-603102, Tamil Nadu, India.
E-mail: sagadevansuresh@gmail.com

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality worldwide. In individuals with mild-to-moderate COPD, serum C-reactive Protein (CRP) corresponds with disease severity and poor health outcomes. Mean Platelet Volume (MPV) is also linked to an elevated degree of inflammation in the body, as well as the severity and acute exacerbation of COPD.

Aim: To evaluate the relationship between serum CRP levels and MPV and its association with COPD severity and the patient’s cardiac abnormality.

Materials and Methods: A cross-sectional study was conducted in the Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, between January 2015 and January 2016. Study was carried out among 55 patients who were diagnosed with COPD in accordance with Global Initiative for Chronic Obstructive Lung Disease 2014 (GOLD) and who were within the age range of 40-70 years were included in the investigation. Severity of airflow obstruction was confirmed by Spirometry using True Flow Easy on PC sensor Pulmonary Function Test (PFT) machine with bronchodilator reversibility testing, as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2014 and abnormality was evaluated by clinical and radiological assessment. A 3 mL of blood was collected into a clot vial and sent for analysis of CRP using an immunoassay system based on antigen-antibody reaction and fluorescence technology and MPV using the impedance count technique. Receiver Operating Characteristic (ROC) curve was used to find out the sensitivity and specificity of MPV and CRP levels with cardiac abnormality. The study was statistically analysed by Pearson’s Chi-square test.

Results: Out of total sample, majority (n=25, 45.5%) were between 51-60 years age group and, there were 35 (63.63%) males and 20 (36.37%) females. The mean CRP levels of mild COPD patients were found to be 6.980±0.7328 mg/dL, moderate and severe COPD patients were found to be 7.243±0.5324 mg/dL and 7.550±0.4950 mg/dL, respectively and it was statistically significant (p-value <0.0001). In the present study, the mean CRP levels and mean MPV were found to be significantly higher in patients with cardiac abnormality than the patients without cardiac abnormality (p-value <0.0001).

Conclusion: Finally, it was concluded that systemic inflammation is common in COPD patients and that CRP and MPV are significant COPD biomarkers for assessing disease severity, predicting cardiac abnormalities, and predicting patient prognosis.

Keywords

Biomarkers, Blood platelets, Chronic obstructive pulmonary disease, Electocardiography

Chronic obstructive pulmonary disease is a complicated chronic inflammatory disease of the lungs that involves a number of inflammatory cells and mediators (1). It is distinguished by cellular inflammation and structural remodeling of small airways, as well as gradual impairment of lung function caused by airway blockage (1),(2). COPD, rather than being an isolated disorder with pathological processes exclusive to the lungs, is a heterogeneous disease with a chronic inflammatory process and systemic symptoms associated to other systemic diseases such as cardiovascular disease, diabetes, metabolic syndrome and osteoporosis [3-5]. To prevent the effects of COPD, the mainstay of treatment is inflammation control. As a result, identifying the inflammatory process and assessing its severity are essential for treatment decisions (6),(7). Many factors, including CRP, Erythrocyte Sedimentation Rate (ESR), MPV, procalcitonin, Vascular Endothelial Growth Factor (VEGF), Tumour Necrosis Factor-alpha (TNF-α), and Interleukin-6 (IL-6) and IL-8 have been determined as inflammatory markers and used for these purposes. A number of these indicators have been used to predict future problems or lung function (8),(9),(10).

C-reactive protein is one of the inflammatory indicators that is increasingly being tested in COPD patients. CRP is a common systemic biomarker that measures an individual’s total systemic inflammatory load (11). In persons with mild-to-moderate COPD, serum CRP levels are associated to disease severity and poor health outcomes. CRP is more commonly utilised due to its availability and cheaper cost (12). In individuals with stable COPD, CRP is also sensitive to changes in the intensity of inflammation, disease exacerbation, or therapy (13). A number of studies support the idea that platelets have a role in the development and progression of COPD (14),(15). Platelet count, MPV, and Platelet Distribution Width (PDW) are frequently used to measure platelet number and function (14),(15).

The outcomes of studies examining the relationship between these parameters in COPD patients were inconsistent (15),(16). Previous research indicates that elevated MPV to an enhanced inflammatory state in the body, as well as the severity and acute exacerbation of COPD (16),(17). A study also discovered that patients with COPD had right ventricular hypertrophy, right atrial enlargement, marked clockwise rotation with poor R-wave progression, Right Bundle Branch Block (RBBB), an S1S2S3 pattern, a QS pattern in leads III and Augmented vector foot (AVf), low voltage in the limb leads, Right Axis Deviation (RAD), Left Axis Deviation (LAD), sinus tachycardia, premature atrial complexes (18). Determining whether the severity of the disease and cardiac abnormalities of COPD was associated with changes in CRP level and MPV independently or in combination will help clinicians to take appropriate decision in treatment. Considering the above factors, CRP levels and MPV in patients with COPD were evaluated in this study and the relationship between serum CRP levels, MPV and its association with the disease severity and also with cardiac abnormalities was also assessed.

Material and Methods

The present cross-sectional study was carried out in the Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, between January 2015 and January 2016. The study was approved from the Institutional Research Ethical Committee of Chettinad Hospital and Research Institute, Kelambakkam (ethical approval: Reg. No: IHC/01/23Jan2015/Desp. No.013/27.02.2015). In compliance with the regulations of the Institutional Research Ethical Committee, patients visiting the Respiratory Medicine outpatient and inpatient clinics were recruited after providing written consent with information in their native understandable language.

The research included 55 stable individuals with COPD. The study comprised participants diagnosed in accordance with GOLD 2014 (19) and aged 40-70 years.

Inclusion criteria: Stable patients with COPD, diagnosed in line with GOLD 2014 and in the age group of 40-70 years were included in the study.

Exclusion criteria: Acute exacerbations of COPD, patients with obstructive airway diseases other than COPD and patients those who were not willing to participate were excluded from the study.

Sample size calculation: According to the pilot study the prevalence of stable COPD cases in the present study centre was 63.8%. The sample size was calculated using the following formula.

n=Z1-a/22 P QL2

Where, n: Sample size; Z: Probability; P: Expected proportion; Q: 100-P; L: Allowable error; 1-α/2: Desired confidence level. Single proportion: Allowable error; Expected proportion-63.8; Allowable error (%)- 20; Desired confidence level (1-alpha)-95%. The minimum sample size required to conduct the study was 55.

Study Procedure

A detailed clinical history and a complete physical examination were performed on patients who were chosen for this study. Spirometry utilising True Flow Easy on PC sensor PFT machine with bronchodilator reversibility testing (as per GOLD Guidelines 2014) validated the diagnosis of COPD and the degree of airflow restriction (19). Cardiac abnormality was evaluated using clinical and radiological assessment. Then 3 mL of blood is drawn in a clot vial and sent for estimation of MPV was done by the impedance count method and CRP was done by Immunoassay system based on antigen-antibody reaction and fluorescence technology.

Electrocardiography (ECG) was performed on all patients using a PHILIPS equipment. A 12-lead ECG was conducted, using three bipolar limb leads, three unipolar limb leads, and six unipolar pericardial leads. Various ECG parameters were observed, including rate, right axis deviation (>+110 degree axis), P-pulmonale (Peaked P-wave >2.5 mm), QRS Complex, T-wave abnormality, Right Ventricle Hypertrophy (RVH), and Right Bundle Branch Block (RBBB).

Statistical Analysis

Based on clinical history and examination, imaging study (Chest X-ray), PFT, MPV and CRP values and patient data were analysed using Statistical Package for the Social Sciences software (SPSS) version 17.0 (MEDCALF). The quantitative variables have been described as Mean+SD or Frequency analysis with numbers and percentage. ROC curve was used to find out the sensitivity and specificity of MPV and CRP levels with cardiac abnormality. The study was statistically analysed by Pearson Chi-square test. With observed value of p-value <0.05 was considered to be statistically significant.

Results

The present study included 55 patients of COPD patients who were attending the tertiary care hospitals, Outpatient Department (OPD) and Inpatient Department (IPD) of Department of Respiratory Medicine. Among study group, 25 (45.5%) subjects between 51-60 years were observed more in number and male gender were predominant (n=35, 63.63%) than female gender (n=20, 36.37%). Regarding occupation 36.36% were homemakers, 30.91% were farmers. In this study, the severity of COPD on the basis of GOLD guidelines, 10 (18.18%) patients were stage-I (mild), 17 (30.91%) were stage-II (moderate) and 28 (50.91%) were stage-III (severe). There were no patients in GOLD stage IV {Forced Expiratory Volume (FEV1) less than 30% of predicted}. In this study, cardiac abnormalities were observed in 28 (50.9%) cases (Table/Fig 1).

In this study, mean CRP levels of patients with cardiac abnormality were found to be 7.22±0.5616 mg/dL and patients without cardiac abnormality were found to be 5.612±0.9015 mg/dL. The observed distribution was statistically significant (p-value <0.0001). CRP levels of >6.3 mg/dL were significantly observed with cardiac abnormality with 96.7% sensitivity and 84.0% specificity. The mean CRP levels of mild COPD patients were found to be 6.980±0.7328 mg/dL, moderate and severe COPD patients were found to be 7.243±0.5324 mg/dL and 7.550±0.4950 mg/dL, respectively and it was statistically significant (p-value <0.0001) (Table/Fig 2),(Table/Fig 3). In the present study, mean MPV levels of patients with cardiac abnormality were found to be 9.180±0.1769 fL and patients without cardiac abnormality were found to be 8.588±0.5167 fL. The observed distribution was statistically significant (p-value <0.0001) and cardiac abnormalities is predicted by MPV levels in the threshold >9.1 with 73.3% sensitivity and 100% specificity with a 95% confidence interval of 0.0878 to 0.997. The observed data was statistically significant with p-value of (p-value <0.0001). The mean MPV levels of mild COPD patients were found to be 9.100 fL, moderate and severe COPD patients were found to be 9.178 and 9.400 fL, respectively and it was statistically significant (p-value <0.0001) (Table/Fig 4),(Table/Fig 5).

The comparison of ROC between CRP and MPV showed that the difference between area was 0.0127, very negligible and Area Under the Curve (AUC) for CRP was 0.925 whereas for MPV was 0.937 which was almost perfect in prediction. Thus, authors interpret that both CRP and MPV can predict cardiac abnormality (Table/Fig 6),(Table/Fig 7).

Discussion

The CRP and MPV levels were higher in stable COPD patients independent of COPD stage or cardiac problems, according to the present study’s primary results. With the growing recognition that COPD is a complex disease involving multiple organs and clearly established low-grade systemic inflammation, biomarkers have become a more important focus of interest in clarifying the pathogenesis and progression of the disease as well as designing new therapeutic targets for the disease (20). Elevated blood CRP levels in COPD patients indicated low grade chronic systemic inflammation in the early 2000s (21). Then, in 2006, de Torres JP et al., reported a link between CRP levels and significant prognostic clinical factors in patients with stable COPD (22).

In this study, the mean CRP levels of patients with cardiac abnormality were found to be significantly higher than the patients without cardiac abnormality. Authors also observed cardiac abnormalities is predicted by CRP levels in the threshold >6.3 with 96.7% sensitivity and 84.0% specificity and mean CRP levels of severes COPD patients was significantly higher than mild and moderate category. Pinto-Plata VM et al., found no significant relationship between the degree of illness and serum CRP levels, but de Torres JP et al., found that serum CRP level rose considerably with disease aggravation (22),(23). Increased levels of inflammatory markers are related with COPD exacerbation owing to airway obstruction and/or severe infection (24). The degree of inflammation is related to the severity of the condition. Serum CRP has been discovered to be highly sensitive to change in response to COPD exacerbation, hence assessing it provides further evidence in identifying COPD exacerbation [25,26]. Bircan A et al., found that elevated CRP levels in COPD patients predicted acute exacerbation with sensitivity of 72.5% and specificity of 100% (27). As a result, serum CRP levels can be used to predict the state of pulmonary function volumes such as FEV1 or other lung function indices. CRP was adversely linked with FEV1 in stable COPD, however in most studies, CRP was preferred and a stronger predictor of FEV1. Higher CRP levels are associated with a decrease in these amounts (28),(29).

In the present study, mean MPV levels of patients with cardiac abnormality were found to be higher than the patients without cardiac abnormality (p-value <0.0001) and the MPV levels predicts cardiac abnormality in the criterion >9.1 which has 73.3% sensitivity and 100% specificity with 95% confidence interval is 0.0878 to 0.997 (p-value <0.0001). The mean MPV levels of severe COPD patients were found to be 9.400 which was higher than mild and moderate categories (p-value <0.0001). Platelet activation has been seen in COPD patients (30). The processes driving platelet activation are unknown, however hypoxia and chronic inflammation have been shown to activate platelets. MPV and PDW is a marker of platelet activation (30).

In several chronic conditions, MPV and PDW have been demonstrated to indicate inflammatory load. When compared to healthy controls, patients with COPD had significantly higher platelet counts and lower MPV, according to Biljak VR et al., (31). MPV levels were considerably higher in hypoxic patients with COPD compared to non hypoxic participants and controls, according to Onder I et al., and Bansal R et al., (32),(33). Patients with more severe COPD had higher MPV levels, according to Kalemci S et al., (34). According to research, inflammation in COPD is associated with platelet activation, as seen by higher MPV (32),(33),(34). According to several research, MPV reduces in individuals with inflammatory illnesses such as COPD, even during severe exacerbations (31),(35). Both Biljak VR et al., and Ulasli SS et al., observed that MPV exhibited no change across COPD severity stages [31,36]. Only Cui H et al., discovered a negative connection between MPV and percentage predicted FEV1, implying that larger MPV indicates more severe blockage, although they used a considerably smaller sample size of very elderly male patients (37).

Mean platelet volume levels in the study may differ due to pre-analytical circumstances and the analysis itself. Age, gender, race, ethnicity, lifestyle and genetic background, venepuncture method, anticoagulant used, type of sample, and many other factors, as well as the analysis itself employing a variety of methodologies, may all have an effect on MPV values (32). Furthermore, inter-individual variability in illness response should be addressed as a factor that influences not just MPV (30). We found the comparison of ROC between CRP and MPV shows that the difference between area is 0.0127, very negligible and AUC for CRP is 0.925 whereas for MPV is 0.937 which is almost perfect in prediction. According to statistical analysis either CRP or MPV may be used to predict the cardiac abnormality in COPD.

Limitation(s)

The limitation of the present study was no follow-up, therefore prognosis of CRP and MVP were not studied.

Conclusion

Finally, the study indicated that COPD patients had systemic inflammation and that CRP, MPV is a useful biomarker in COPD for predicting disease severity and patient prognosis. Cardiac co-morbidities in COPD have a significant association with inflammatory markers and the severity of the disease. As a consequence, the use of inflammatory markers might help anticipate the emergence of cardiac co-morbidities, allowing for improved COPD treatment options. Further large-scale, well-designed studies are needed to further investigate the relationship between CRP and MPV in diagnosis of COPD.

References

1.
Chung KF, Adcock IM. Multifaceted mechanisms in COPD: Inflammation, immunity, and tissue repair and destruction. Eur Respir J. 2008;31(6):1334-56. [crossref][PubMed]
2.
Wouters E. COPD: From obstructive lung disease to chronic systemic inflammatory syndrome? Pneumologie. 2009;63:S107-12. [crossref][PubMed]
3.
Sevenoaks MJ, Stockley RA. Chronic obstructive pulmonary disease, inflammation and co-morbidity- A common inflammatory phenotype? Respir Res. 2006;7:01-09. [crossref][PubMed]
4.
Sutherland ER, Martin RJ. Airway inflammation in chronic obstructive pulmonary disease: comparisons with asthma. J Allergy Clin Immunol. 2003;112(5):819-27. [crossref]
5.
Garrod R, Marshall J, Barley E, Fredericks S, Hagan G. The relationship between inflammatory markers and disability in chronic obstructive pulmonary disease (COPD). Prim Care Respir J. 2007;16(4):236-40. [crossref][PubMed]
6.
Heidari B, Heidari P, Tayebi ME. The value of changes in CRP and ESR for predicting treatment response in rheumatoid arthritis. APLAR J Rheumatol. 2007;10(1):23-28. [crossref]
7.
Karadag F, Kirdar S, Karul AB, Ceylan E. The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med. 2008;19(2):104-08. [crossref][PubMed]
8.
Kirdar S, Serter M, Ceylan E, Sener AG, Kavak T, Karadag? F. Adiponectin as a biomarker of systemic inflammatory response in smoker patients with stable and exacerbation phases of chronic obstructive pulmonary disease. Scand J Clin Lab Invest. 2009;69(2):219-24. [crossref][PubMed]
9.
Bafadhel M, Clark TW, Reid C, Medina MJ, Batham S, Barer MR, et al. Procalcitonin and C-reactive protein in hospitalised adult patients with community acquired pneumonia, exacerbation or COPD. Chest. 2011;139(6):1410-18. [crossref][PubMed]
10.
Antonescu-Turcu AL, Tomic R. C-reactive protein and copeptin prognostic predictors in chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2009;15(2):120-25. [crossref][PubMed]
11.
Yende S, Waterer GW, Tolley EA, Newman AB, Bauer DC, Taaffe DR, et al. Inflammatory markers are associated with ventilatory limitation and muscle dysfunction in obstructive lung disease in well-functioning elderly subjects. Thorax. 2006;61(1):10-16. [crossref][PubMed]
12.
Man SF, Connett JE, Anthonisen NR, Wise RA, Tashkin DP, Sin DD. C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease. Thorax. 2006;61(10):849-53. [crossref][PubMed]
13.
Thomsen M, Ingebrigtsen TS, Marott JL, Dahl M, Lange P, Vestbo J, et al. Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease. JAMA. 2013;309(22):2353-61. [crossref][PubMed]
14.
Zinellu A, Paliogiannis P, Sotgiu E, Mellino S, Fois AG, Carru C, et al. Platelet count and platelet indices in patients with stable and acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2021;18(2):231-45. [crossref][PubMed]
15.
Mallah H, Ball S, Sekhon J, Parmar K, Nugent K. Platelets in chronic obstructive pulmonary disease: An update on pathophysiology and implications for antiplatelet therapy. Respiratory Medicine. 2020;171:106098. [crossref][PubMed]
16.
Ulasli SS, Ozyurek BA, Yilmaz EB, Ulubay G. Mean platelet volume as an inflammatory marker in acute exacerbation of chronic obstructive pulmonary disease. Pol Arch Med Wewn. 2012;122(6):284-90. [crossref][PubMed]
17.
Ma Y, Zong D, Zhan Z, Li H, Dai Z, Cui Y, et al. Feasibility of mean platelet volume as a biomarker for chronic obstructive pulmonary disease: A systematic review and meta-analysis. Journal of International Medical Research. 2019;47(12):5937-49. [crossref][PubMed]
18.
Holtzman D, Aronow WS, Mellana WM, Sharma M, Mehta N, Lim J, et al. Electrocardiographic abnormalities in patients with severe versus mild or moderate chronic obstructive pulmonary disease followed in an academic outpatient pulmonary clinic. Annals of Noninvasive Electrocardiology. 2011;16(1):30-32. [crossref][PubMed]
19.
Gold WM, Koth LL. Chapter 25. Pulmonary function testing. In: Broaddus VC, Mason RJ, Ernst JD, King TE, Lazarus SC, Murray JF, et al., editors. Murray and Nadel’s Textbook of Respiratory Medicine. 6th ed. Philadelphia: Saunders/Elsevier; 2015. pp. 407-435.e18.[crossref][PubMed]
20.
Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. European Respiratory Journal. 2009;33(5):1165-85. [crossref][PubMed]
21.
Aksu F, Capan N, Aksu K, Ofluog? lu R, Canbakan S, Yavuz B, et al. C-reactive protein levels are raised in stable Chronic obstructive pulmonary disease patients independent of smoking behavior and biomass exposure. Journal of Thoracic Disease. 2013;5(4):414.
22.
de Torres JP, Cordoba-Lanus E, López-Aguilar C, Muros de Fuentes M, Montejo de Garcini A, Aguirre-Jaime A, et al. C-reactive protein levels and clinically important predictive outcomes in stable COPD patients. Eur Respir J. 2006;27(5):902-07. [crossref][PubMed]
23.
Pinto-Plata VM, Müllerova H, Toso JF, Feudjo-Tepie M, Soriano JB, Vessey RS, et al. C-reactive protein in patients with COPD, control smokers and non-smokers. Thorax. 2006;61(1):23-28. [crossref][PubMed]
24.
Heidari B. The importance of C-reactive protein and other inflammatory markers in patients with chronic obstructive pulmonary disease. Caspian Journal of Internal Medicine. 2012;3(2):428.
25.
Gallego M, Pomares X, Capilla S, Marcos MA, Suárez D, Monsó E, et al. C-reactive protein in outpatients with acute exacerbation of COPD: Its relationship with microbial etiology and severity. International Journal of Chronic Obstructive Pulmonary Disease. 2016;11:2633. [crossref][PubMed]
26.
Osei-Bimpong A, Meck JH, Lewis SM. ESR or CRP? A comparison of their clinical utility. Hematology. 2007;12(4):353-57. [crossref][PubMed]
27.
Bircan A, Gokirmak M, Kilic O, Ozturk O, Akkaya A. C-reactive protein levels in patients with chronic obstructive pulmonary disease: Role of infection. Med Princ Pract. 2008;17:202-08. [crossref][PubMed]
28.
Monadi M, Firouzjahi A, Hosseini A, Javadian Y, Sharbatdaran M, Heidari B. Serum C-reactive protein in asthma and its ability in predicting asthma control, a case-control study. Caspian Journal of Internal Medicine. 2016;7(1):37.
29.
Nerpin E, Jacinto T, Fonseca JA, Alving K, Janson C, Malinovschi A. Systemic inflammatory markers in relation to lung function in NHANES. 2007-2010. Respiratory Medicine. 2018;142:94-100. [crossref][PubMed]
30.
Zinellu A, Paliogiannis P, Sotgiu E, Mellino S, Fois AG, Carru C, et al. Platelet count and platelet indices in patients with stable and acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2021;18(2):231-45. [crossref][PubMed]
31.
Biljak VR, Pancirov D, C ? epelak I, Popovic´ -Grle S, Stjepanovic´ G, Grubišic´ TŽ. Platelet count, mean platelet volume and smoking status in stable chronic obstructive pulmonary disease. Platelets. 2011;22(6):466-70. [crossref][PubMed]
32.
Onder I, Topcu S, Dökmetas HS, Türkay C, Seyfikli Z. Platelet aggregation size and volume in chronic obstructive pulmonary disease. Mater Med Pol. 1997;29:11-13.
33.
Bansal R, Gupta HL, Goel A, Yadav M. Association of increased platelet volume in patients of chronic obstructive pulmonary disease: Clinical implications. J Indian Acad Clin Med. 2002;3(2):169-72.
34.
Kalemci S, Akin F, Sarihan A, Sahin C, Zeybek A, Yilmaz N. Relationship between hematological parameters and severity of chronic obstructive pulmonary disease. Pol Arch Intern Med. 2018;128(3):171-77. [crossref][PubMed]
35.
Wang M, Zhang J, Ji Q, Yang Q, Zhao F, Li W, et al. Evaluation of platelet distribution width in chronic obstructive pulmonary disease patients with pulmonary embolism. Biomark Med. 2016;10(6):587-96. [crossref][PubMed]
36.
Ulasli SS, Ozyurek BA, Yilmaz EB, Ulubay G. Mean platelet volume as an inflammatory marker in acute exacerbation of chronic obstructive pulmonary disease. Pol Arch Med Wewn. 2012;122(6):284-90. [crossref][PubMed]
37.
Cui H, Liu L, Wei Z, Wang D, Hu Y, Hu G, et al. Clinical value of mean platelet volume for impaired cardiopulmonary function in very old male patients with chronic obstructive pulmonary disease. Arch Gerontol Geriatr. 2012;54(2):109-12.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/62784.18059

Date of Submission: Jan 16, 2023
Date of Peer Review: Feb 07, 2023
Date of Acceptance: May 08, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 19, 2023
• Manual Googling: Apr 18, 2023
• iThenticate Software: May 04, 2023 (11%)

ETYMOLOGY: Author Origin

EMENDATIONS: 8

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