C-Reactive Protein Changes in Adult and Pediatric People With Cystic Fibrosis During Treatment of Pulmonary Exacerbations

Jonathan B Zuckerman; Alexandra C Hinton; Thomas Lahiri; Charlotte C Teneback; Shijing Jia; Joel Mermis; Deepika Polineni; Elliott Dasenbrook; Hossein Sadeghi; Emily DiMango; Rebecca Dezube; Natalie E West; Edith T Zemanick; Z Nasr Samya; Alex H Gifford

doi:10.1002/ppul.27487

C-Reactive Protein Changes in Adult and Pediatric People With Cystic Fibrosis During Treatment of Pulmonary Exacerbations

Pediatr Pulmonol. 2025 Jan;60(1):e27487. doi: 10.1002/ppul.27487.

Authors

Affiliations

¹ Maine Medical Center, Division of Pulmonary and Critical Care, Portland, Maine, USA.
² Center for Outcomes and Research Evaluation, Maine Medical Center, Portland, Maine, USA.
³ Division of Pediatric Pulmonology, University of Vermont Medical Center, Burlington, Vermont, USA.
⁴ Division of Pulmonary and Critical Care, University of Vermont Medical Center, Burlington, Vermont, USA.
⁵ Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Division of Pulmonary and Critical Care, University of Kansas Medical Center, Kansas City, Missouri, USA.
⁷ Division of Allergy and Pulmonary Medicine, Washington University, St. Louis, Missouri, USA.
⁸ Division of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
⁹ Columbia University Medical Center, Division of Pediatric Pulmonology, New York, New York, USA.
¹⁰ Columbia University Medical Center, Division of Pulmonary and Critical Care, New York, New York, USA.
¹¹ Johns Hopkins Medical Center, Division of Pulmonary and Critical Care, Baltimore, Maryland, USA.
¹² Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, USA.
¹³ Division of Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ University Hospitals Cleveland Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Cleveland, Ohio, USA.

PMID: 39835779
DOI: 10.1002/ppul.27487

Abstract

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.

Keywords: C‐reactive protein; cystic fibrosis; pulmonary exacerbation.

MeSH terms

Adolescent
Adult
Age Factors
Anti-Bacterial Agents* / therapeutic use
C-Reactive Protein* / analysis
Child
Child, Preschool
Cystic Fibrosis* / blood
Cystic Fibrosis* / complications
Cystic Fibrosis* / drug therapy
Cystic Fibrosis* / physiopathology
Disease Progression
Female
Humans
Lung / drug effects
Lung / physiopathology
Male
Young Adult

Substances

C-Reactive Protein
Anti-Bacterial Agents

Grants and funding

This work was supported by the Cystic Fibrosis Foundation through a grant to J.B.Z. (ZUCKER18A01) and in part by the Northern New England Clinical and Translational Research grant (U54GM115516).