***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background : TORCH ( Towards a Revolution in COPD Health ) is an international multicentre , r and omised , placebo-controlled clinical trial of inhaled fluticasone propionate/salmeterol combination treatment and its monotherapy components for maintenance treatment of moderately to severely impaired patients with chronic obstructive pulmonary disease ( COPD ) . The primary outcome is all-cause mortality . Cause-specific mortality and deaths related to COPD are additional outcome measures , but systematic methods for ascertainment of these outcomes have not previously been described . Methods : A Clinical Endpoint Committee ( CEC ) was tasked with categorising the cause of death and the relationship of deaths to COPD in a systematic , unbiased and independent manner . The key elements of the operation of the committee were the use of predefined principles of operation and definitions of cause of death and COPD -relatedness ; the independent review of cases by all members with development of a consensus opinion ; and a substantial infrastructure to collect medical information . Results : 911 deaths were review ed and consensus was reached in all . Cause-specific mortality was : cardiovascular 27 % , respiratory 35 % , cancer 21 % , other 10 % and unknown 8 % . 40 % of deaths were definitely or probably related to COPD . Adjudications were identical in 83 % of blindly re-adjudicated cases ( κ = 0.80 ) . COPD -relatedness was reproduced 84 % of the time ( κ = 0.73 ) . The CEC adjudication was equivalent to the primary cause of death recorded by the site investigator in 52 % of cases . Conclusion : A CEC can provide st and ardised , reliable and informative adjudication of COPD mortality that provides information which frequently differs from data collected from assessment by site investigators RATIONALE Chronic obstructive pulmonary disease ( COPD ) seems to be a heterogeneous disease with a variable course . OBJECTIVES We wished to characterize the heterogeneity and variability of COPD longitudinally . METHODS In the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints ( ECLIPSE ) study of 2,164 patients with clinical ly stable COPD , 337 smokers with normal lung function , and 245 never-smokers , we measured a large number of clinical parameters , lung function , exercise tolerance , biomarkers , and amount of emphysema by computed tomography . All three groups were followed for 3 years . MEASUREMENTS AND MAIN RESULTS We found a striking heterogeneity among patients with COPD , with poor correlations between FEV1 , symptoms , quality of life , functional outcomes , and biomarkers . Presence of systemic inflammation was found in only a limited proportion of patients , and did not relate to baseline characteristics or disease progression , but added prognostic value for predicting mortality . Exacerbations tracked over time and added to the concept of the " frequent exacerbator phenotype . " Disease course was very variable , with close to a third of patients not progressing at all . Risk factors for 3-year change in both FEV1 and lung density were assessed . For FEV1 decline , continued smoking and presence of emphysema were the strongest predictors of progression ; club cell protein was found to be a potential biomarker for disease activity . For progression of emphysema , the strongest predictors were continued smoking and female sex . CONCLUSIONS By following a large , well characterized cohort of patients with COPD over 3 years , we have a clearer picture of a heterogeneous disease with clinical ly important subtypes ( " phenotypes " ) and a variable and not inherently progressive course . Clinical trial registered with www . clinical trials.gov ( NCT00292552 ) Background In patients with acute hypercapnic respiratory failure ( AHRF ) during exacerbations of COPD , mortality can be high despite noninvasive ventilation ( NIV ) . For some , AHRF is terminal and NIV is inappropriate . However there is no definitive method of identifying patients who are unlikely to survive . The aim of this study was to identify factors associated with inpatient mortality from AHRF with respiratory acidosis due to COPD . Methods COPD patients presenting with AHRF and who were treated with NIV  were studied prospect ively . The forced expiratory volume in 1 second ( FEV1 ) , World Health Organization performance status ( WHO-PS ) , clinical observations , a composite physiological score ( Early Warning Score ) , routine hematology and biochemistry , and arterial blood gases prior to commencing NIV , were recorded . Results In total , 65 patients were included for study , 29 males and 36 females , with a mean age of 71 ± 10.5 years . Inpatient mortality in the group was 33.8 % . Mortality at 30 days and 12 months after admission were 38.5 % and 58.5 % , respectively . On univariate analysis , the variables associated with inpatient death were : WHO-PS ≥ 3 , long-term oxygen therapy , anemia , diastolic blood pressure < 70 mmHg , Early Warning Score ≥ 3 , severe acidosis ( pH < 7.20 ) , and serum albumin < 35 g/L. On multivariate analysis , only anemia and WHO-PS ≥ 3 were significant . The presence of both predicted 68 % of inpatient deaths , with a specificity of 98 % . Conclusion WHO-PS ≥ 3 and anemia are prognostic factors in AHRF with respiratory acidosis due to COPD . A combination of the two provides a simple method of identifying patients unlikely to benefit from NIV Long-term outcomes in patients surviving community-acquired pneumonia ( CAP ) are still incompletely understood . This study investigates the association of clinical parameters and blood markers with long-term mortality . We prospect ively followed 877 CAP patients from a previous multicentre trial for 18 months follow-up and investigated all-cause mortality following hospital discharge . Overall mortality was 17.3 % ( 95 % CI 14.8–19.8 % ) with a 12.8 % ( 95 % CI 10.9–15.0 % ) mortality incidence rate per year . Initial risk assignment using the Pneumonia Severity Index was accurate during the 18 month follow-up . Multivariable regression models ( hazard ratio , 95 % CI ) design ated the following as independent risk factors for long-term mortality : male sex ( 1.7 , 1.2–2.5 ) ; chronic obstructive pulmonary disease ( 1.5 , 1.1–2.1 ) ; neoplastic disease ( 2.5 , 1.7–3.7 ) ; and highest quartile of peak pro-adrenomedullin level ( 3.3 , 1.7–6.2 ) . Initial presentation with temperature > 38.7 ° C ( 0.4 , 0.2–0.6 ) , chills ( 0.6 , 0.4–0.99 ) and highest quartile of the inflammatory marker C-reactive-protein ( 0.3 , 0.2–0.5 ) were independent protective factors . A weighted risk score based on these variables showed good discrimination ( area under receiver operating characteristic curve 0.78 , 95 % CI 0.74–0.82 ) . Pronounced clinical and laboratory signs of systemic inflammatory host response upon initial hospital stay were associated with favourable long-term prognosis . Further studies should address whether closer monitoring of high-risk CAP patients after hospital discharge favourably impacts long-term mortality Inflammation is increased in chronic obstructive pulmonary disease ( COPD ) and plays a role in exercise intolerance . We investigated whether pravastatin administration is effective in improving exercise capacity in patients with COPD , and whether baseline or serial changes in high-sensitivity C-reactive protein ( hs-CRP ) over time are associated with corresponding changes in exercise capacity . In a r and omized , double-blinded , and parallel design , 125 patients with clinical ly stable COPD were r and omly assigned to receive placebo or pravastatin ( 40 mg/day ) over a period of 6 months . Plasma hs-CRP levels were measured before r and omization and during follow-up . Baseline characteristics were similar in the 2 groups . Exercise time remained stable throughout the study in the placebo group . Exercise time increased by 54 % from 599 + /- 323 seconds at baseline to 922 + /- 328 seconds at the end ( p < 0.0001 ) in pravastatin-treated patients . A decrease in hs-CRP over baseline values was observed in 79 % of patients ( 42 of 53 ) treated with pravastatin . Pravastatin-treated patients with a greater percent decrease in hs-CRP had a significant improvement in exercise time compared with those without hs-CRP decrease . A significant correlation was found in univariate analysis between decrease of log-transformed hs-CRP and increase of exercise time . Baseline hs-CRP and change of hs-CRP were significantly correlated with exercise time , even after adjustment for lipid profiles and hemodynamics . In conclusion , these data reinforce hs-CRP as a significant surrogate marker in COPD and underscore an important guide to the efficacy of treatment in COPD trials BACKGROUND Statins lower the levels of low-density lipoprotein ( LDL ) cholesterol and C-reactive protein ( CRP ) . Whether this latter property affects clinical outcomes is unknown . METHODS We evaluated relationships between the LDL cholesterol and CRP levels achieved after treatment with 80 mg of atorvastatin or 40 mg of pravastatin per day and the risk of recurrent myocardial infa rct ion or death from coronary causes among 3745 patients with acute coronary syndromes . RESULTS Patients in whom statin therapy result ed in LDL cholesterol levels  of less than 70 mg per deciliter ( 1.8 mmol per liter ) had lower event rates than those with higher levels ( 2.7 vs. 4.0 events per 100 person-years , P=0.008 ) . However , a virtually identical difference was observed between those who had CRP levels of less than 2 mg per liter after statin therapy and those who had higher levels ( 2.8 vs. 3.9 events per 100 person-years , P=0.006 ) , an effect present at all levels of LDL cholesterol achieved . For patients with post-treatment LDL cholesterol levels  of more than 70 mg per deciliter , the rates of recurrent events were 4.6 per 100 person-years among those with CRP levels of more than 2 mg per liter and 3.2 events per 100 person-years among those with CRP levels of less than 2 mg per liter ; the respective rates among those with LDL cholesterol levels of less than 70 mg per deciliter were 3.1 and 2.4 events per 100 person-years ( P<0.001 ) . Although atorvastatin was more likely than pravastatin to result in low levels of LDL cholesterol and CRP , meeting these targets was more important in determining the outcomes than was the specific choice of therapy . Patients who had LDL cholesterol levels of less than 70 mg per deciliter and CRP levels of less than 1 mg per liter after statin therapy had the lowest rate of recurrent events ( 1.9 per 100 person-years ) . CONCLUSIONS Patients who have low CRP levels after statin therapy  have better clinical outcomes than those with higher CRP levels , regardless of the result ant level of LDL cholesterol . Strategies to lower cardiovascular risk with statins should include monitoring CRP as well as cholesterol BACKGROUND & AIMS Chronic respiratory failure ( CRF ) is the common fate of respiratory diseases where systemic effects contribute to outcomes . In a prospect i ve cohort of home-treated patients with CRF , we looked for predictors of long-term survival including respiratory , nutritional and inflammatory dimensions . METHODS 637 stable out patients with CRF , 397 men , 68 ± 11 years , on long-term oxygen therapy and /or non-invasive ventilation from 21 chest clinics were enrolled and followed over 53 ± 31 months . CRF result ed from Chronic Obstructive Pulmonary Disease ( COPD ) in 48.5 % , restrictive disorders 32 % , mixed ( obstructive and restrictive patterns ) respiratory failure 13.5 % , bronchiectasis 6 % . Demographic characteristics , smoking habits , underlying respiratory diseases , forced expiratory volume in one second ( FEV1 ) , forced vital capacity ( FVC ) , arterial blood gases , 6-min walking distance ( 6MWD ) , hemoglobin , body mass index ( BMI ) , serum albumin , transthyretin , C-reactive protein ( CRP ) , history of respiratory assistance , antibiotic and oral corticosteroid use during the previous year were recorded . RESULTS  322 deaths  occurred during the follow-up . One- , five- and 8-year actuarial survival was 89 % , 56 % and 47 % . By Cox univariate analysis , age , respiratory disease , PaO2 , PaCO2 , FEV1/FVC , BMI , 6MWD , activity score , type and length of home respiratory assistance , smoking habits , oral corticosteroid and antibiotic uses , albumin , transthyretin , hemoglobin and CRP levels were associated with survival . Multivariate analysis identified eight independent markers of survival : age , FEV1 
    Output:
    
Our analysis indicates that  baseline high CRP level  is significantly associated with higher late mortality  in patients with COPD .