Abstract
Background: rational prescription of antibiotics in acute exacerbation of COPD (AECOPD) requires predictive markers. Acute phase reactants are capable of demonstrating the inflammation; however, they cannot be employed to make a difference between bacterial and non-bacterial causes of the inflammation. The bacterial infection plays an important role in the exacerbation of COPD patients. Recently, measurement of serum procalcitonin levels appears to be useful in order to minimize this problem. We aim to evaluate the prognostic and diagnostic
Methods & methods: 51 COPD patients with bacterial exacerbations, 47 patients without bacterial exacerbations, similar age and sex were included in the study. PCT levels in the serum samples were measured in all subjects.
Results: Procalcitonin levels ranged from 0.01 to 12.03 ng/ml. Mean levels were 3.18±2.60 ng/ml in Group I and 0.23±0.39 ng/ml in Group II. Median values in Groups I and II were 2.98 and 0.09 ng/ml respectively. Statistically, there was a significant difference between two groups (p<0.001) with Group I showing a higher mean value as compared to Group II. A significant near strong correlation was observed between TLC levels and serum Proclacitonin levels (r=0.699; p<0.001). However, a weak negative and borderline significant correlation.
Conclusions: This study found increased PCT serum levels among AECOPD patients and suggests a role for PCT in the predicting of the bacterial exacerbations and their needs for ventilator support. We recommend other large studies to augment our endings.
References
Murray CJ, Lopez AD. Evidence-based health policy--lessons from the Global Burden of Disease Study. Sci. 1996;274(5288):740-3.
WHO. World health report: Geneva WHO. 2013.
WHO. World Health Organization. Burden of COPD. Available from: http://www.who.int/respiratory/copd/burden/en/. [Last accessed on 2013 Jun 5]. 2013.
Salvi S, Agrawal A. India needs a national COPD prevention and control programme. J Assoc Physician India. 2012;60 Suppl:5-7.
Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006;27(2):397-412.
Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;161(5):1608-13.
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(4):752-63.
Pena VS, Miravitlles M, Gabriel R, Jimenez-Ruiz CA, Villasante C, Masa JF, et al. Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentre epidemiological study. Chest. 2000;118(4):981-9.
Talamo C, de Oca MM, Halbert R, Perez-Padilla R, Jardim JR, Muino A, et al. Diagnostic labeling of COPD in five Latin American cities. Chest. 2007;131(1):60-7.
Behrendt CE. Mild and moderate-to-severe COPD in nonsmokers: distinct demographic profiles. Chest. 2005;128(3):1239-44.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3(11):442.
Raad D, Gaddam S, Schunemann HJ, Irani J, Abou Jaoude P, Honeine R, et al. Effects of water-pipe smoking on lung function: a systematic review and meta-analysis. Chest. 2011;139(4):764-74.
Tan WC, Lo C, Jong A, Xing L, FitzGerald MJ, Vollmer WM, et al. Marijuana and chronic obstructive lung disease: a population-based study. Canadian Med Ass J. 2009;180(8):814-20.
WHO. WHO Study Group on Tobacco Product Regulation. Water pipe smoking: health effects, research needs, and recommended actions by regulators. Geneva, Switzerland: World Health Organization. 2005.
Tetrault JM, Crothers K, Moore BA, Mehra R, Concato J, Fiellin DA. Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med. 2007; 167(3):221-8.
(US) OoSaH. The Health Consequences of Involuntary Exposure to Tobacco Smoke A Report of the Surgeon General. (Available from https//: www.ncbi.nlm.nih.govbooks/NBK44324/). 2006.
Eisner MD, Balmes J, Katz PP, Trupin L, Yelin EH, Blanc PD. Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease. Environ Health. 2005;4(1):7.
Dayal HH, Khuder S, Sharrar R, Trieff N. Passive smoking in obstructive respiratory disease in an industrialized urban population. Environ Res. 1994;65(2):161-71.
Leuenberger P, Schwartz J, Ackermann-Liebrich U, Blaser K, Bolognini G, Bongard JP, et al. Passive smoking exposure in adults and chronic respiratory symptoms (SAPALDIA Study). Swiss Study on Air Pollution and Lung Diseases in Adults, SAPALDIA Team. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1222-8.
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(2):206-17.
Muller B, Becker KL, Schachinger 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(4):977-83.
Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents. 2002;20(1):1-9.
van Leeuwen HJ, Voorbij HA. [Procalcitonin concentrations in the diagnosis of acute inflammatory reactions]. Ned Tijdschr Geneeskd. 2002;146(2):55-9.
Müller B, Prat C. Markers of acute inflammation in assessing and managing lower respiratory tract infections: focus on procalcitonin. Clin Microbiol Inf. 2006; 12:8-16.
Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, Muller B. Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Crit Care Med. 2004;32(8):1715-21.
Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004;363(9409):600-7.
Rey C, Los Arcos M, Concha A, Medina A, Prieto S, Martinez P, et al. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children. Intensive Care Med. 2007;33(3):477-84.
Christ-Crain M, Stolz D, Bingisser R, Muller 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(1):84-93.
Schuetz P, Christ-Crain M, Muller B. Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections--hope for hype? Swiss Med Wkly. 2009;139(23-24):318-26.
Chang C, Yao WZ, Chen YH, Liu ZY, Zhang XW. [The changes and clinical implications of serum procalcitonin in acute exacerbations of chronic obstructive pulmonary disease]. Zhonghua Jie He He Hu Xi Za Zhi. 2006;29(7):444-7.
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(6):1410-8.
Murphy TF, Sethi S, Niederman MS. The role of bacteria in exacerbations of COPD. A constructive view. Chest. 2000;118(1):204-9.
Monso E, Ruiz J, Rosell A, Manterola J, Fiz J, Morera J, et al. Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush. Am J Respir Crit Care Med. 1995;152(4 Pt 1):1316-20.
Martinez FJ. Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc. 2007;4(8):647-58.
Sethi S, Evans N, Grant BJ, Murphy TF. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. New Engl J Med. 2002;347(7):465-71.
Schuetz P, Albrich W, Christ-Crain M, Chastre J, Mueller B. Procalcitonin for guidance of antibiotic therapy. Expert Rev Anti Infect Ther. 2010;8(5):575-87.
Cantürk T, Arzu B, Nuri K, Satilmis I, Selim K, Metin Ö, et al. The Importance of Serum Procalcitonin Levels in Patients with Chronic Obstructive Pulmonary Disease Exacerbations. Turkish J Med Sci. 2008;38(2):139-44.
Daniels JM, Schoorl M, Snijders D, Knol DL, Lutter R, Jansen HM, et al. Procalcitonin vs C-reactive protein as predictive markers of response to antibiotic therapy in acute exacerbations of COPD. Chest. 2010;138(5):1108-15.
Kherad O, Kaiser L, Bridevaux P-O, Sarasin F, Thomas Y, Janssens J-P, et al. Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations. Chest. 2010;138(4):896-904.
How to cite this article:
Bhaskar R, Singh S, Singh S, Singh SK, Gaur PS and Pandey S. Measurement of Procalcitonin in acute exacerbation of COPD and its correlation to Spirometric Indices. Int. J. Res. Dev. Pharm. L. Sci. 2017; 6(6): 2833-2839. Doi: 10.13040/IJRDPL.2278-0238.6(6). 2833-2839.
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