Serum Procalcitonin as a Biomarker for the Prediction of Bacterial Exacerbation and Mortality in Severe COPD Exacerbations Requiring Mechanical Ventilation

Abstract

Background: Procalcitonin (PCT) is being used as a marker of bacterial infections. Although there are several studies showing the diagnostic yield of PCT to differentiate bacterial involvement in chronic obstructive pulmonary disease exacerbations (COPDE), the prognostic yield of PCT in severe COPDE has been studied less. Objectives: The primary aim was to determine whether the level of serum PCT at admission in severe COPDE serves as a prognostic biomarker for hospital mortality. The secondary aim was to determine the role of PCT in identifying a bacterial exacerbation. Methods: A total of 63 COPDE patients (median age 71 years; male 58.7%) were retrospectively analyzed from our intensive care unit database. Results: The hospital mortality rate was 23.8%. Admission PCT levels were higher in patients who died during hospitalization (0.66 vs. 0.17 ng/ml; p = 0.014). This association between hospital mortality and serum PCT level remained significant in a multivariate analysis; for every 1 ng/ml increase in PCT level, hospital mortality increased 1.85 times (odds ratio; 95% confidence interval: 1.07-3.19; p = 0.026). The optimal admission PCT threshold was 0.25 ng/ml in order to discern patients who had bacterial exacerbation with a sensitivity of 63%, a specificity of 67%, and a negative predictive value of 80%. The negative predictive value increased to 89% when both the admission and follow-up PCT levels remained <0.25 ng/ml. Conclusion: This study shows that admission PCT levels have a prognostic importance in estimating hospital mortality among patients with severe COPDE. A PCT level <0.25 ng/ml at the time of admission and during follow-up is suggestive of the absence of a bacterial cause of COPDE.

Clinical differences between eosinophilic and non-eosinophilic acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a multicenter cross-sectional study

“…In a meta-analysis, Ni W et al showed that the sensitivity and speci city of PCT in diagnosing bacterial infections were 0.60 and 0.76, and AUC of ROC curve was 0.77 [44]. Ergan B et al found that compared with culture-negative patients, PCT was markedly increased in culture-positive patients in AECOPD [45]. Their data also showed that 0.25 ng/ml was the optimal cut-off value, with 63% sensitivity, 67% speci city, and 0.73 AUC, to predict bacterial infection in AECOPD.…”

Effect of Pingchuan Guben decoction on patients with chronic obstructive pulmonary disease: Results from a randomized comparative effectiveness research trial

“…PCT is a precursor of the hormone calcitonin, and PCT is expressed in neuroendocrine cells of the intestine and the lung (39). PCT has been proposed to have a prognostic importance in exacerbations of COPD (40,41). SAA is a member of the apolipoprotein family, which contributes to the aggravation of the inflammatory response through activation of neutrophil and other inflammatory cells (42,43).…”

Antibiotic Decision in Severe Chronic Obstructive Pulmonary Disease Exacerbations

“…We thank Giorgi-Pierfranceschi et al [1] for their interest in our study [2] . Antibiotic decision in severe chronic obstructive pulmonary disease (COPD) exacerbations is always a dilemma, especially in critically ill patients with acute respiratory failure.…”