Citation Information :
Mishra AR, Prakash V, Verma S, Kushwaha R, Kumar S, Srivastava A, Bajaj D. Procalcitonin as a Diagnostic Marker in Patients of Acute Bacterial Exacerbation of Chronic Obstructive Pulmonary Disease. Indian J Chest Dis Allied Sci 2020; 62 (2):57-60.
Objective: Common factors for exacerbation of chronic obstructive pulmonary disease (COPD) are viral and bacterial infections. Presence of purulent sputum for the initiation of antibiotic therapy is non judicious because antibiotic usage in viral exacerbation may lead to the development of bacterial resistance and unnecessary economic burden on the patient. Procalcitonin (PCT) is a marker which can be used to differentiate between viral and bacterial causes as an aetiology of these exacerbations.
Methods: Patients with exacerbation of COPD (increased dyspnoea, cough, increased sputum volume and/or purulence) were identified. Sputum culture was sent along with serum PCT levels. Patients were divided into two groups –Group I (COPD patients with bacterial exacerbation, confirmed by the sputum culture) and Group II (COPD patients without bacterial exacerbation). Serum PCT levels were measured in both the groups.
Results: Results of the study revealed that PCT levels ranged from 0.01 to and 12.03 ng/mL with a mean value of 3.18±2.60 ng/mL in Group I and 0.23±0.39 ng/mL in Group II and median values of 2.98 ng/mL in Group I and 0.09 ng/mL in Group II. There was a statistically significant difference between the two groups (P<0.001) with Group I showing a higher mean values compared to Group II. A significant near strong correlation was observed between total leucocyte count and PCT levels (r=0.699; P<0.001). However, a weak negative and borderline significant correlation between forced expiratory volume in one second/forced vital capacity (FEV1/FVC) levels and PCT levels was observed (r=–0.199; P=0.050).
Conclusion: Procalcitionin can be used to differentiate between bacterial and viral exacerbation of COPD. PCT- guided antibiotic therapy has a potential to decrease the unnecessary use of antibiotics and economic burden on the patient.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study
World Health Organization. Burden of COPD. Available from URL: http://www.who.int/respiratory/copd/burden/en/. Accessed on June 5, 2013.
Salvi S, Agarwal A. India needs a national COPD prevention and control program. J Assoc Physicians India 2012;60 (Suppl.):5–7.
Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, et al. COPD in never smokers: results from the population-based burden of obstructive lung disease study. Chest 2011;139:752–63.
Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest 2000;117:398S–401S.
Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002;57:847–52.
White AJ, Gompertz S, Stockley RA. Chronic obstructive pulmonary disease: the aetiology of exacerbations of chronic obstructive pulmonary disease. Thorax 2003;58:73–80.
Ram FS, Rodriguez-Roisin R, Granados-Navarrete A, Garcia-Aymerich J, Barnes NC. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006;19:CD004403.
Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004;39:206–17.
Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977–83.
Carrol ED, Thomson APJ, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents 2002;20:1–9.
Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, Müller B. Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Crit Care Med 2004;32:1715–21.
Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006;174:84–93.
Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitoninguided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomized, single blinded intervention trial. Lancet 2004;363(9409):600–607.
Chang C, Yao W Z, Chen Y H, Liu ZY, Zhang XW. The changes and clinical implications of serum procalcitonin in acute exacerbations of chronic obstructive pulmonary disease. ZhounghaJie He He Hu Xi ZaZhi 2006;29:444–7.
Canturk T, Arzu B, Nuri K, et al. The importance of serum procalcitonin levels in patients with chronic obstructive pulmonarydisease exacerbations. Turk J Med Sci 2008;38;139–144.
Lacoma A, Prat C, Andreo F, Lores L, Ruiz-Manzano J, Ausina V, et al. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2011;6:157–69.
Bafadhel M, Clark TW, Reid C, Medina MJ, Batham S, Barer MR, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest 2011;139:1410–18.