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Patients with persistent systemic inflammation have a higher mortality rate and more frequent episodes of acute exacerbation ( Several studies have identified the presence of potentially pathogenic microorganisms (PPM) in the lower respiratory tract of patients with stable COPD, which may lead to systemic inflammation and increased serum C-reactive protein (CRP), interleukin-8 (IL-8) levels and plasma fibrinogen (FIB) (94, 95)