TY - JOUR T1 - Multi-level differential network analysis of COPD exacerbations JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00075-2017 VL - 50 IS - 3 SP - 1700075 AU - Guillaume Noell AU - Borja G. Cosío AU - Rosa Faner AU - Eduard Monsó AU - German Peces-Barba AU - Alfredo de Diego AU - Cristobal Esteban AU - Joaquim Gea AU - Robert Rodriguez-Roisin AU - Marian Garcia-Nuñez AU - Francisco Pozo-Rodriguez AU - Susana G. Kalko AU - Alvar Agustí Y1 - 2017/09/01 UR - http://erj.ersjournals.com/content/50/3/1700075.abstract N2 - Patients with chronic obstructive pulmonary disease (COPD) often suffer episodes of exacerbation (ECOPD) that impact negatively the course of their disease. ECOPD are heterogeneous events of unclear pathobiology and non-specific diagnosis. Network analysis is a novel research approach that can help unravelling complex biological systems. We hypothesised that the comparison of multi-level (i.e., clinical, physiological, biological, imaging and microbiological) correlation networks determined during ECOPD and convalescence can yield novel patho-biologic information.In this proof-of-concept study we included 86 patients hospitalised because of ECOPD in a multicentre study in Spain. Patients were extensively characterised both during the first 72 h of hospitalisation and during clinical stability, at least 3 months after hospital discharge.We found that 1) episodes of ECOPD are characterised by disruption of the network correlation observed during convalescence; and 2) a panel of biomarkers that include increased levels of dyspnoea, circulating neutrophils and C-reactive protein (CRP) has a high predictive value for ECOPD diagnosis (AUC 0.97).We conclude that ECOPD 1) are characterised by disruption of network homeokinesis that exists during convalescence; and 2) can be identified objectively by using a panel of three biomarkers (dyspnoea, circulating neutrophils and CRP levels) frequently determined in clinical practice.This is the first study to investigate COPD exacerbations using multi-level differential network analysis http://ow.ly/uYlW30eMpwR ER -