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Hoult G, Gillespie D, Wilkinson TMA, Thomas M, Francis NA. Biomarkers to guide the use of antibiotics for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis. BMC Pulm Med 2022; 22:194. [PMID: 35549921 PMCID: PMC9101830 DOI: 10.1186/s12890-022-01958-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Antibiotics are frequently prescribed for acute exacerbations of COPD (AECOPD) even though most do not have a bacterial aetiology. Biomarkers may help clinicians target antibiotic use by identifying AECOPD caused by bacterial pathogens. We aimed to summarise current evidence on the diagnostic accuracy of biomarkers for detecting bacterial versus non-bacterial AECOPD. Methods We searched Embase and Medline using a search strategy including terms for COPD, biomarkers and bacterial infection. Data regarding diagnostic accuracy for each biomarker in predicting bacterial cause of exacerbation were extracted and summarised. We used to QUADAS-2 tool to assess risk of bias. Results Of 509 papers identified, 39 papers evaluating 61 biomarkers were eligible for inclusion. Moderate quality evidence was found for associations between serum C-reactive protein (CRP), serum procalcitonin (PCT), sputum interleukin (IL)-8 and sputum tumour necrosis factor alpha (TNF-α), and the presence of bacterial pathogens in the sputum of patients with AECOPD. Having bacterial pathogens was associated with a mean difference (higher) CRP and PCT of 29.44 mg/L and 0.76 ng/mL respectively. There was inconsistent or weak evidence for associations between bacterial AECOPD and higher levels of sputum IL-1β, IL-6, myeloperoxidase (MPO) and neutrophil elastase (NE). We did not find any consistent evidence of diagnostic value for other biomarkers. Conclusions There is moderate evidence from heterogeneous studies that serum CRP and PCT are of value in differentiating bacterial from non-bacterial AECOPD, and little evidence for other biomarkers. Further high-quality research on the role of biomarkers in identifying bacterial exacerbations is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01958-4.
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Affiliation(s)
- George Hoult
- Cardiff University School of Medicine, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK
| | - David Gillespie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Tom M A Wilkinson
- Clinical and Experimental Sciences, Faculty of Medicine, Southampton General Hospital, Southampton University, Mailpoint 810, Level F, South Block, Southampton, SO16 6YD, UK.,NIHR Southampton BRC - Respiratory Theme, Faculty of Medicine, Southampton General Hospital, Southampton University, Mailpoint 810, Level F, South Block, Southampton, SO16 6YD, UK
| | - Mike Thomas
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Nick A Francis
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, SO16 5ST, UK.
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2
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Ye YP, Zhao H, Kang T, Zhao LH, Li N, Chen J, Peng XX. Optimal cut-off value of serum procalcitonin in predicting bacterial infection induced acute exacerbation in chronic obstructive pulmonary disease: A prospective observational study. Chron Respir Dis 2022; 19:14799731221108516. [PMID: 35830291 PMCID: PMC9284202 DOI: 10.1177/14799731221108516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To explore the optimal cut-off value of serum procalcitonin (PCT) level in
predicting bacterial infection in hospitalized patients with acute
exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods 204 hospitalized patients with AECOPD were enrolled in this study. Their
diagnoses and treatments followed routine protocols in Fu-Xing Hospital
affiliated to Capital Medical University, Beijing, China. Extra blood
samples were taken for serum PCT level testing and the results were blinded
to the treating physicians. On discharge, clinical data were collected and
the treating physicians made comprehensive analyses to determine whether the
AECOPD were triggered by respiratory tract bacterial infection or
non-bacterial causes according to the “new diagnostic criteria” defined in
this study. In the AECOPD patients with bacterial infection, treating
physicians decided whether they had bacterial pneumonia based on imaging
studies. Receiver operating characteristic curve (ROC) was used to analyze
the accuracy of serum PCT level in predicting bacterial infection. Results In the 173 AECOPD patients who did not have pneumonia, 115 had evidences of
bacterial infection while 58 did not. The median PCT levels were 0.1(0.08,
0.18) ng/ml and 0.07 (0.05, 0.08) ng/ml for each group, which were
statistically different. The proposed optimal cut-off value of serum PCT
level in predicting bacterial infection was 0.08 ng/mL according to this
study, with a sensitivity of 81%, specificity of 67% and area under the ROC
curve (AUC) of 0.794. There were 31 AECOPD patients diagnosed with
pneumonia, their median PCT level was 0.23 ng/mL. Conclusions The serum PCT levels slightly increased in the majority of hospitalized
patients with AECOPD compared with reference range. When PCT level was
≥0.08 ng/mL, AECOPD was more likely to be caused by bacterial infection. A
significantly elevated PCT levels may indicate combination of AECOPD and
bacterial pneumonia.
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Affiliation(s)
- Yan-Ping Ye
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Hang Zhao
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Tao Kang
- Department of Laboratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Li-Hua Zhao
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Ning Li
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Jing Chen
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Xiao-Xia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, 12517Capital Medical University, National Center for Children's Health, Beijing, China
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3
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Pázmány P, Soós A, Hegyi P, Dohos D, Kiss S, Szakács Z, Párniczky A, Garami A, Péterfi Z, Molnár Z. Inflammatory Biomarkers Are Inaccurate Indicators of Bacterial Infection on Admission in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease-A Systematic Review and Diagnostic Accuracy Network Meta-Analysis. Front Med (Lausanne) 2021; 8:639794. [PMID: 34869399 PMCID: PMC8636902 DOI: 10.3389/fmed.2021.639794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/21/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction: The value of inflammatory biomarkers in the diagnosis of bacterial infection induced acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is currently unclear. Our objective was to investigate the diagnostic accuracy of on-admission inflammatory biomarkers in differentiating bacterial origin in AECOPD. Methods: Systematic literature search was performed to include cross-sectional studies on AECOPD patients with microbiological culture results as gold standard, and at least one on-admission inflammatory biomarker determined from serum: C-reactive protein (CRP), procalcitonin (PCT), neutrophil/lymphocyte ratio, eosinophil percentage, CD64index; or sputum: neutrophil elastase, tumor necrosis factor alfa, interleukin-1-beta (IL-1b), interleukin-8, sputum color, as index tests. We ranked index tests by superiority indices in a network meta-analysis and also calculated pooled sensitivity and specificity. Results: Altogether, 21 eligible articles reported data on 2,608 AECOPD patients (44% bacterial). Out of the 14 index tests, sputum IL-1b showed the highest diagnostic performance with a pooled sensitivity of 74% (CI: 26–97%) and specificity of 65% (CI: 19–93%). Pooled sensitivity for CRP and PCT were: 67% (CI: 54–77%) and 54% (CI: 39–69%); specificity 62% (CI: 52–71%) and 71% (CI: 59–79%), respectively. Conclusion: Admission inflammatory biomarkers are inaccurate indicators of bacterial infection in AECOPD. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#myprospero, identifier: 42020161301.
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Affiliation(s)
- Piroska Pázmány
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Department of General Medicine and Pulmonology, Heim Pál National Institute for Pediatrics, Budapest, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Alexandra Soós
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Dóra Dohos
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Szabolcs Kiss
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Szakács
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Andrea Párniczky
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.,Department of Gastroenterology, Heim Pál National Institute for Pediatrics, Budapest, Hungary
| | - András Garami
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Zoltán Péterfi
- Department of Internal Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Molnár
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.,Centre for Translational Medicine, Semmelweis University, Faculty of Medicine, Budapest, Hungary.,Department of Anesthesiology and Intensive Therapy, Medical Faculty, Poznan University for Medical Sciences, Poznan, Poland.,Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Faculty of Medicine, Budapest, Hungary
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4
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Usefulness of serum procalcitonin for necrotizing fasciitis as an early diagnostic tool. J Infect Chemother 2021; 27:787-793. [PMID: 33454216 DOI: 10.1016/j.jiac.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/08/2020] [Accepted: 01/02/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION While the early diagnosis of necrotizing fasciitis (NF) is crucial and could lead to a favorable outcome, it is difficult to differentiate NF from cellulitis, resulting in delay for the appropriate treatment. PATIENTS AND METHODS For the purpose of examining which diagnostic tools could correctly differentiate NF from cellulitis, we conducted this case-control study. We retrospectively reviewed all patients who were diagnosed with NF at our institute during 2014-2019. The patients who were diagnosed with cellulitis were randomly selected during the study period as the control group. The severity of NF is evaluated by serum-procalcitonin (PCT), LRINEC score, NTSI assessment and SIARI score. RESULTS A total of 25 NF patients were enrolled in this study. The median age was 68 years (range 39-79) and 18 (72%) were male. Comparing NF and cellulitis groups, NF group showed a higher LRINEC score and serum PCT than cellulitis group did, even though there was no statistical significance in serum PCT. With respect to the diagnostic value for differentiating NF from cellulitis, the area under the ROC curve for of serum PCT and LRINEC scores were 0.928 [95% confidential interval (CI) 0.864-0.992, p < 0.001] and 0.846 (95% CI 0.757-0.936, p < 0.001). The appropriate serum-PCT cutoff value was 1.0 and had a sensitivity of 88%, a specificity of 89%, a positive predictive value of 81%, and a negative predictive value of 93%. CONCLUSION Serum-PCT could be a useful diagnostic marker for differentiating diagnosis of NF from cellulitis.
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Chen K, Pleasants KA, Pleasants RA, Beiko T, Washburn RG, Yu Z, Zhai S, Drummond MB. Procalcitonin for Antibiotic Prescription in Chronic Obstructive Pulmonary Disease Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective. Pulm Ther 2020; 6:201-214. [PMID: 32676981 PMCID: PMC7672148 DOI: 10.1007/s41030-020-00123-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Indexed: 10/26/2022] Open
Abstract
The 2020 Global Initiative for Obstructive Lung Disease report indicates that the blood biomarker procalcitonin (PCT) may assist in decision-making regarding the initiation of antibiotics for chronic obstructive pulmonary disease (COPD) exacerbations. PCT is an acute-phase reactant that increases in response to inflammation and infection, and has been studied in various bacterial infections for initiation and de-escalation of antibacterials. The purpose of this systematic review and meta-analysis was to evaluate the strength of the data on the use of PCT to guide antibiotic prescription in COPD exacerbations. Among the randomized clinical trials included in our meta-analysis, almost all of which were conducted exclusively in the hospital setting. PCT was found to decrease overall antibiotic exposure in COPD exacerbations by 2.01 days (p = 0.04), while no apparent effects were found on clinical outcomes (length of hospital stay, p = 0.88; treatment failure p = 0.51; all-cause mortality p = 0.28). However, the majority of blood PCT levels in COPD exacerbations were below the manufacturer-recommended cutoff for antibiotics, and the use of this marker was associated with worse outcomes in the intensive care setting. Further, based on additional sensitivity analysis excluding studies with high risk of bias or with converted outcome value, the effect of PCT on antibiotic duration in RCTs was no longer significant (MD = -1.88 days, 95% CI [-3.95, 0.19] days, p = 0.08, and MD = -1.72 days, 95% CI [-4.28, 0.83] days, p = 0.19, respectively). Our review and analysis does not support the use of PCT to guide antibiotic prescription in COPD exacerbations.
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Affiliation(s)
- Ken Chen
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Roy A Pleasants
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Tatsiana Beiko
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Ronald G Washburn
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Zhiheng Yu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Jin H, Yang S, He P, Weng H, Liu S, Yang F, Zhang L, Fan F, Zhang Y, Zhou J, Li J. Serum Procalcitonin Levels on Admission Predict Death in Severe and Critical COVID-19 Patients in Wuhan, China. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2020. [DOI: 10.15212/cvia.2019.0582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: We evaluated whether the serum procalcitonin (PCT) level could predict death in severe and critical coronavirus disease 2019 (COVID-19) patients.Methods: This study included 129 COVID-19 patients. PCT levels on admission, treatment, and death were collected.
The outcomes were compared.Results: The optimum cutoff value of the PCT level determined by receiver operator characteristic curve analysis to predict all-cause death was 0.085 ng/mL, with sensitivity of 95.7% and specificity of 72.6%. Overall, 78 patients had a PCT level below
0.085 ng/mL and 51 patients had a PCT level of 0.085 ng/mL or greater. High-PCT-level patients had lower levels of lymphocytes (P=0.001) and albumin (P=0.002) and higher levels of creatinine (P=0.024), D-dimer (P=0.002), and white blood cells, neutrocytes (P<0.001), high-sensitivity C-reactive
protein (P<0.001), interleukin-6 (P<0.001), interleukin-8 (P=0.001), interleukin-10 (P=0.001), tumor necrosis factor (P<0.001), erythrocyte sedimentation rate (P=0.001), and ferritin (P=0.001). During the 30-day observation period, 23 patients died. Mortality was significantly higher
in high-PCT-level patients than in patients with low PCT levels (43.1% vs. 1.3%; P<0.001). The risks of death (P<0.0001) and ventilator use (P<0.0001) were increased in patients with PCT levels of 0.085 ng/mL or greater.Conclusions: A PCT level of 0.085 ng/mL or greater
on admission could effectively predict death and ventilator use in severe and critical COVID-19 patients.
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Affiliation(s)
- Han Jin
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Shengwen Yang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi road, Xicheng
District, 100037 Beijing, China
| | - Pengkang He
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Haoyu Weng
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Shengcong Liu
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Fan Yang
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Long Zhang
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Jing Zhou
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034 Beijing, China
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Crisafulli E, Manco A, Ferrer M, Huerta A, Micheletto C, Girelli D, Clini E, Torres A. Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease. Semin Respir Crit Care Med 2020; 41:817-829. [PMID: 32726837 DOI: 10.1055/s-0040-1702196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively. Abnormal host defense mechanisms may play a role in the specificity of the systemic inflammatory response. Given the association of this aspect to some biomarkers at admission (e.g., C-reactive protein), it can be used to help to discriminate AECOPD and CAP, especially in cases with doubtful infiltrates and advanced lung impairment. Fever, sputum purulence, chills, and pleuritic pain are typical clinical features of CAP in a patient with COPD, whereas isolated dyspnea at admission has been reported to predict AECOPD. Although CAP may have a worse outcome in terms of mortality (in hospital and short term), length of hospitalization, and early readmission rates, this has only been confirmed in a few prospective studies. There is a lack of methodologically sound research confirming the impact of severe AECOPD and COPD + CAP. Here, we review studies reporting head-to-head comparisons between AECOPD and CAP + COPD in hospitalized patients. We focus on the epidemiology, risk factors, systemic inflammatory response, clinical and microbiological characteristics, outcomes, and treatment approaches. Finally, we briefly discuss some proposals on how we should orient research in the future.
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Affiliation(s)
- Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.,Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandra Manco
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Miquel Ferrer
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
| | - Arturo Huerta
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
| | - Claudio Micheletto
- Department of Cardiovascular and Thoracic, Pneumology Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enrico Clini
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia and University Hospital of Modena Policlinico, Modena, Italy
| | - Antoni Torres
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES (CB06/06/0028), University of Barcelona, Barcelona, Spain
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8
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Azzini AM, Dorizzi RM, Sette P, Vecchi M, Coledan I, Righi E, Tacconelli E. A 2020 review on the role of procalcitonin in different clinical settings: an update conducted with the tools of the Evidence Based Laboratory Medicine. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:610. [PMID: 32566636 PMCID: PMC7290560 DOI: 10.21037/atm-20-1855] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Biomarkers to guide antibiotic treatment decisions have been proposed as an effective way to enhancing a more appropriate use of antibiotics. As a biomarker, procalcitonin (PCT) has been found to have good specificity to distinguish bacterial from non-bacterial inflammations. Decisions regarding antibiotic use in an individual patient are complex and should be based on the pre-test probability for bacterial infection, the severity of presentation and the results of PCT serum concentration. In the context of a high pre-test probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track the resolution of infection and decisions regarding early stop of antibiotic treatment. As outlined by the Evidence Based Laboratory Medicine (EBLM), not only the pre-test probability but also the positive likelihood ratio influence the performance of a test do be really diagnostic. This aspect should be taken into account in the interpretation of the results of clinical trials evaluating the performance of PCT in guiding antibiotic therapy.
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Affiliation(s)
- Anna Maria Azzini
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Romolo Marco Dorizzi
- Clinical Pathology Unit, Department of Pathology, Transfusion and Laboratory Medicine, Ravenna, Italy
| | - Piersandro Sette
- Hospital Management and Organization Department, Hospital of San Bonifacio, San Bonifacio, VR, Italy
| | - Marta Vecchi
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ilaria Coledan
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elda Righi
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Evelina Tacconelli
- Section of Infectious Disease, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tubingen, Tubingen, Germany
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9
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Pandey S, Garg R, Kant S, Verma A, Gaur P. Serum procalcitonin levels in chronic obstructive pulmonary disease patients in North Indian Population. Ann Afr Med 2019; 18:103-107. [PMID: 31070153 PMCID: PMC6521643 DOI: 10.4103/aam.aam_44_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Exacerbations in Chronic obstructive pulmonary disease (COPD) have a considerable impact on morbidity, mortality, and quality of life. Procalcitonin (PCT) a polypeptide normally produced in neuroendocrine cells of the thyroid and lungs is a marker of systemic inflammation and bacterial infection. Objectives The aim of this study was to determine the levels of PCT in serum of acute exacerbation of COPD patients (AECOPD) and stable COPD patients in North Indian population. Materials and Methods The study was conducted on 80 AECOPD and 80 stable COPD patients in respiratory medicine department at tertiary care hospital in north India. PCT levels were measured in serum by ELISA kit. GraphPad Prism version 6.01 (GraphPad software Inc.; La, Jolla, CA, USA) was used for analysis of data. Results The present study showed that mean serum PCT levels were significantly higher in AECOPD group (1.31 ± 0.79) as compared to stable COPD group (0.1 ± 0.09) (P < 0.001). Conclusion The study confirms that PCT levels were higher in AECOPD patients as compared to stable COPD patients. PCT could be used as a biomarker of exacerbations of COPD and can be used to target management and guiding the treatment in patients with acute exacerbations of COPD.
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Affiliation(s)
- Sarika Pandey
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajiv Garg
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Surya Kant
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Verma
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Priyanka Gaur
- Department of Physiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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10
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Ni W, Bao J, Yang D, Xi W, Wang K, Xu Y, Zhang R, Gao Z. Potential of serum procalcitonin in predicting bacterial exacerbation and guiding antibiotic administration in severe COPD exacerbations: a systematic review and meta-analysis. Infect Dis (Lond) 2019; 51:639-650. [PMID: 31355690 DOI: 10.1080/23744235.2019.1644456] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The value of procalcitonin (PCT) in the diagnosis of bacterial infections and for determining antibiotic usage among patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is currently unclear. Methods: We systematically reviewed the literature and selected studies that evaluated PCT as a biomarker for predicting bacterial infection and compared PCT-based protocols to determine its application in the initiation or discontinuation of antibiotics. Guidance for systematic reviews from Cochrane and the GRADE were followed to perform this study. Data were pooled and analyzed by using a random-effects or a fixed-effects model based on the heterogeneity. Results: The pooled sensitivity and specificity of PCT in diagnosing respiratory bacterial infections were 0.60 and 0.76, respectively, with the area under the summary receiver operating characteristic curve of 0.77. Subgroup analysis showed that the sensitivity and specificity of PCT for patients in ICU were 0.48 and 0.69, respectively. PCT-based protocols decreased antibiotic prescription (relative risk = 0.66, 95% CI: 0.62-0.71) and total antibiotic exposure (mean difference = -2.60, 95% CI: -4.48-0.72), without affecting clinical outcomes such as treatment failure, length of hospitalization and rates of re-exacerbation or overall mortality. Conclusions: PCT has a moderate ability to distinguish bacterial respiratory infection in patients with AECOPD. PCT-guided algorithm can reduce unnecessary administration of antibiotics without increasing adverse outcomes. However, for patients requiring admission in the ICU, PCT may have a poor diagnostic value, and the PCT-guided algorithm may not effectively and safely reduce the antibiotic exposure.
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Affiliation(s)
- Wentao Ni
- a Department of Respiratory and Critical Care Medicine, Peking University People's Hospital , Beijing , China
| | - Jing Bao
- a Department of Respiratory and Critical Care Medicine, Peking University People's Hospital , Beijing , China
| | - Donghong Yang
- a Department of Respiratory and Critical Care Medicine, Peking University People's Hospital , Beijing , China
| | - Wen Xi
- a Department of Respiratory and Critical Care Medicine, Peking University People's Hospital , Beijing , China
| | - Keqiang Wang
- a Department of Respiratory and Critical Care Medicine, Peking University People's Hospital , Beijing , China
| | - Yu Xu
- a Department of Respiratory and Critical Care Medicine, Peking University People's Hospital , Beijing , China
| | - Rongbao Zhang
- a Department of Respiratory and Critical Care Medicine, Peking University People's Hospital , Beijing , China
| | - Zhancheng Gao
- a Department of Respiratory and Critical Care Medicine, Peking University People's Hospital , Beijing , China
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Abedini A, Kiani A, Emami H, Touhidi MH. Serum Procalcitonin Level as a Predictor of Bacterial Infection in Patients with COPD Exacerbation. TANAFFOS 2019; 18:112-117. [PMID: 32440298 PMCID: PMC7230128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a major cause of mortality and morbidity throughout the world. Although the cause of COPD exacerbations can be bacterial or viral, use of antibiotics in exacerbations remains controversial. Procalcitonin serum level dramatically increases in bacterial infections, but not in viral or noninfectious febrile diseases. The aim of this study is to investigate whether the measurement of procalcitonin can be used to differentiate bacterial from non-bacterial causes of COPD exacerbations. MATERIALS AND METHODS Sixty-eight COPD patients admitted to the emergency department of Masih Daneshvari Hospital due to COPD exacerbation were studied. At admission and before prescribing antibiotics, we obtained sputum and blood samples for sputum gram staining and culture and measured serum C-reactive protein and procalcitonin. All results were analyzed by SPSS software version 22. RESULTS A total of 68 patients including 51 males and 17 females were studied. From 38.2% of patients a respiratory pathogen was isolated from their sputum and 23.5% of patients had elevated serum procalcitonin values. Using Fisher exact test, we found strong correlation between elevated procalcitonin levels above 0.5 ng/ml and sputum culture results (P < 0.01). We also found strong correlation between elevated procalcitonin levels above 0.5 ng/ml with abnormal C-reactive protein levels in a group of patients with positive sputum culture, using Fisher exact test (P <0.01). CONCLUSION As sputum culture and microbiologic studies are time consuming and sometimes expensive, it seems that procalcitonin could be a reliable marker of bacterial infection in COPD exacerbation, although we recommend a larger study with larger sample to consolidate the finding of this study.
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Affiliation(s)
- Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Emami
- Tobacco Prevention and Control Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Touhidi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Touhidi MH, Address: Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
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12
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Pantzaris ND, Spilioti DX, Psaromyalou A, Koniari I, Velissaris D. The Use of Serum Procalcitonin as a Diagnostic and Prognostic Biomarker in Chronic Obstructive Pulmonary Disease Exacerbations: A Literature Review Update. J Clin Med Res 2018; 10:545-551. [PMID: 29904438 PMCID: PMC5997414 DOI: 10.14740/jocmr3458w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/21/2018] [Indexed: 01/10/2023] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major complication in COPD patients which can be triggered by bacterial or viral infections, environmental pollutants and other causes. Procalcitonin (PCT), a peptide that markedly increases in cases of bacterial infection, has been extensively investigated as a biomarker in the diagnosis, prognosis and treatment in patients with AECOPD. A number of studies published in the last decade, tried to investigate whether PCT levels can differentiate between bacterial and other causes of exacerbations, if they can be used as a guide for optimal antibiotic therapy and if they can be a tool in the assessment of the severity and the need for further interventions in the management of those patients. This review aims to gather, summarize and critically present all the available data to date.
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Affiliation(s)
| | | | | | - Ioanna Koniari
- Department of Interventional Electrophysiology, Royal Brompton Hospital, London, UK
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13
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Zhao Y, Li F, Liu Y, Shi Y, Li Z, Cao G, Zhu W. Comparison of efficiency of inhaled and intravenous corticosteroid on pregnant women with COPD and the effects on the expression of PCT and hs-CRP. Exp Ther Med 2018; 15:4717-4722. [PMID: 29805491 PMCID: PMC5952096 DOI: 10.3892/etm.2018.6011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/19/2018] [Indexed: 11/29/2022] Open
Abstract
The efficiency of inhaled and systemic corticosteroids on pregnant women with chronic obstructive pulmonary disease (COPD) was investigated. The study also compared the effects of the administration on the expression of inflammatory mediator procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP). A total of 120 pregnant COPD patients were recruited and randomly allocated into the following three groups: Intravenous corticosteroid treatment group (n=42), inhaled corticosteroid treatment group (n=38), and control group (without any corticosteroid treatment, n=40). Patients of the all three groups received symptomatic supportive treatments including oxygen therapy, anti-infection therapy, expectorant, and bronchodilator. The serum PCT and hs-CRP expression levels were measured before treatment and after 7 days of treatment. Moreover, the clinical parameters such as symptoms, blood gas analysis parameters, pulmonary function indexes, fasting blood glucose (FBG) and adverse reactions were recorded. The overall clinical effective rates of the group received budesonide inhalation and the group receiving systemic methylprednisolone treatment were comparable. Both treatments were able to reduce the levels of inflammatory mediators, hs-CRP and PCT. On the other hand, treatments increased PaO2 of arterial blood gas while reducing PaCO2, thereby improving the lung function (FEV1% pred and FEV1/FVC) (P>0.05). The study observed that the FBG levels in COPD patients receiving systemic corticosteroid treatment were significantly increased, while budesonide inhalation did not significantly affect the FBG levels. In addition, rates of adverse events (such as mouth dry, oral ulcers, hoarseness) of systemic corticosteroid treatment group were significantly higher than those in inhaled corticosteroid treatment group and control group (38.1% vs. 17.5% vs. 5.0%, comparison between groups: P<0.05). In conclusion, inhaled and systemic use of corticosteroid both significantly improved dyspnea and other clinical symptoms of pregnant COPD patients by increasing oxygen partial pressure, correcting hypoxemia, and enhancing lung function. Moreover, fewer adverse reactions were observed with inhaled corticosteroid treatment, suggesting that inhaled administration is a relatively good, safe and effective treatment for pregnant COPD patients.
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Affiliation(s)
- Yuliang Zhao
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Fei Li
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Yangwen Liu
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Yingjun Shi
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Zhihai Li
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Guangke Cao
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Wang Zhu
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
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14
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Choi JJ, McCarthy MW. Novel applications for serum procalcitonin testing in clinical practice. Expert Rev Mol Diagn 2017; 18:27-34. [PMID: 29148856 DOI: 10.1080/14737159.2018.1407244] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Procalcitonin has emerged as a reliable marker of acute bacterial infection in hospitalized patients and the assay has recently been incorporated into several clinical algorithms to reduce antimicrobial overuse, but its use in patients with end-organ dysfunction is controversial. Areas covered: In this review, the authors examine what is known about procalcitonin testing in patients with organ dysfunction, including those with end-stage renal disease, congestive heart failure, chronic obstructive pulmonary disease, and cirrhosis, and explore how the assay is now being used in the management of non-infectious diseases. Expert commentary: Procalcitonin holds tremendous promise to identify a diverse set of medical conditions beyond those associated with acute bacterial infection, including post-surgical anastomotic leaks, acute kidney injury, and complications after intracerebral hemorrhage. The authors review recent studies examining procalcitonin in these areas and explore how the assay might be used to guide diagnosis and prognosis of non-infectious diseases in the near future.
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Affiliation(s)
- Justin J Choi
- a Division of General Internal Medicine , Weill Cornell Medical College, New York-Presbyterian Hospital , New York , NY , USA
| | - Matthew W McCarthy
- a Division of General Internal Medicine , Weill Cornell Medical College, New York-Presbyterian Hospital , New York , NY , USA
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15
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Lowe CF, Payne M, Puddicombe D, Mah A, Wong D, Kirkwood A, Hull MW, Leung V. Antimicrobial stewardship for hospitalized patients with viral respiratory tract infections. Am J Infect Control 2017; 45:872-875. [PMID: 28526309 DOI: 10.1016/j.ajic.2017.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The purpose of this study was to implement a targeted antimicrobial stewardship intervention for patients with a viral respiratory tract infection. METHODS This was a quasi-experimental before and after audit and feedback intervention of adult inpatients with a positive polymerase chain reaction for a respiratory virus in 2 acute care hospitals in Vancouver, Canada. Audit and feedback was implemented based on 2 criteria: microbiology (no positive bacterial cultures) and chest imaging (absence of pneumonia or consolidation on radiology dictation). A chart review was conducted to assess for days of antibiotics postviral diagnosis. Outcomes including length of stay, intensive care unit admission within 14 days, mechanical ventilation within 14 days, antibiotics prescribed within 14 days, Clostridium difficile infection diagnosed within 30 days, and readmission within 30 days were also reviewed in comparison with the previous year. RESULTS Antimicrobial stewardship recommendations for hospitalized patients with viral respiratory tract infections were accepted for 77% of cases. This targeted approach based on easily assessed parameters translated into a 1.3-day (95% confidence interval, 0.3-2.3; P < .01) decrease in mean days of antibiotics postviral diagnosis compared with the previous year without systematic interventions. Compared with the previous year, no differences were identified for adverse outcomes associated with the intervention. CONCLUSIONS A targeted antimicrobial stewardship intervention integrating virology testing with the treating physician facilitated a reduction in duration of antibiotic treatment for viral respiratory tract infections.
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16
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Mathioudakis AG, Chatzimavridou-Grigoriadou V, Corlateanu A, Vestbo J. Procalcitonin to guide antibiotic administration in COPD exacerbations: a meta-analysis. Eur Respir Rev 2017; 26:26/143/160073. [PMID: 28143877 PMCID: PMC9488925 DOI: 10.1183/16000617.0073-2016] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023] Open
Abstract
Challenges in the differentiation of the aetiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to significant overuse of antibiotics. Serum procalcitonin, released in response to bacterial infections, but not viral infections, could possibly identify AECOPD requiring antibiotics. In this meta-analysis we assessed the clinical effectiveness of procalcitonin-based protocols to initiate or discontinue antibiotics in patients presenting with AECOPD.Based on a prospectively registered protocol, we reviewed the literature and selected randomised or quasi-randomised trials comparing procalcitonin-based protocols to initiate or discontinue antibiotics versus standard care in AECOPD. We followed Cochrane and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidance to assess risk of bias, quality of evidence and to perform meta-analyses.We included eight trials evaluating 1062 patients with AECOPD. Procalcitonin-based protocols decreased antibiotic prescription (relative risk (RR) 0.56, 95% CI 0.43-0.73) and total antibiotic exposure (mean difference (MD) -3.83, 95% CI (-4.32--3.35)), without affecting clinical outcomes such as rate of treatment failure (RR 0.81, 0.62-1.06), length of hospitalisation (MD -0.76, -1.95-0.43), exacerbation recurrence rate (RR 0.96, 0.69-1.35) or mortality (RR 0.99, 0.58-1.69). However, the quality of the available evidence is low to moderate, because of methodological limitations and small overall study population.Procalcitonin-based protocols appear to be clinically effective; however, confirmatory trials with rigorous methodology are required.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, University Hospital of South Manchester, University of Manchester, Manchester, UK
| | | | - Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Moldova
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University Hospital of South Manchester, University of Manchester, Manchester, UK
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17
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Lu Y, Jin W, Zhang H, Zhang X. [Multicenter clinical efficacy observation of integrated Traditional Chinese Medicine-Western Medicine treatment in acute onset period of pulmonary heart disease]. J TRADIT CHIN MED 2016; 36:283-90. [PMID: 27468541 DOI: 10.1016/s0254-6272(16)30039-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy of integrated Traditional Chinese Medicine-Western Medicine (TCM-WM) in the treatment of acute onset pulmonary heart disease (PHD). METHODS A total of 240 patients met the inclusion criteria and were enrolled. These inpatients were divided into group A (treatment group) and B (control group) in order of admission according to the principles of randomization and control. The research was performed simultaneously in three hospitals. Two groups were given basic treatment that included: controlled oxygen therapy, active and effective anti-infection, maintaining airway patency, correcting O2 deficiency and CO2 retention, correcting acid-base imbalance and electrolyte disturbance, reducing pulmonary hypertension and treating right heart failure, nutritional support and treatment of.complications. Group A was given basic treatment and integrated Traditional Chinese Medicine (TCM) differentiating therapy; group B was given basic therapy and a placebo that was similar in appearance and taste to TCM medicinal broth of pharmaceutical preparations, provided by Yibin Pharmaceutical Company (Yibin, China, Wuliangye Group). RESULTS The mortality in the treatment group decreased by 4.98% compared with the control group. The treatment group reported improved ventilation, corrected hypoxemia, improved nutritional status and promoted digestive functions. It also significantly improved the patient's self-life skills, improved the patient's quality of life and could shorten the length of hospital stay. CONCLUSION Comprehensive integrated TCM-WM treatment showed good clinical efficacy toward the acute onset period of PHD patients.
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18
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Comparison of Serum Levels of Procalcitonin and C-Reactive Protein in Patients with Community Acquired Pneumonia and COPD Exacerbation. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.25811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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19
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Kapasi AJ, Dittrich S, González IJ, Rodwell TC. Host Biomarkers for Distinguishing Bacterial from Non-Bacterial Causes of Acute Febrile Illness: A Comprehensive Review. PLoS One 2016; 11:e0160278. [PMID: 27486746 PMCID: PMC4972355 DOI: 10.1371/journal.pone.0160278] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/15/2016] [Indexed: 12/17/2022] Open
Abstract
Background In resource limited settings acute febrile illnesses are often treated empirically due to a lack of reliable, rapid point-of-care diagnostics. This contributes to the indiscriminate use of antimicrobial drugs and poor treatment outcomes. The aim of this comprehensive review was to summarize the diagnostic performance of host biomarkers capable of differentiating bacterial from non-bacterial infections to guide the use of antibiotics. Methods Online databases of published literature were searched from January 2010 through April 2015. English language studies that evaluated the performance of one or more host biomarker in differentiating bacterial from non-bacterial infection in patients were included. Key information extracted included author information, study methods, population, pathogens, clinical information, and biomarker performance data. Study quality was assessed using a combination of validated criteria from the QUADAS and Lijmer checklists. Biomarkers were categorized as hematologic factors, inflammatory molecules, cytokines, cell surface or metabolic markers, other host biomarkers, host transcripts, clinical biometrics, and combinations of markers. Findings Of the 193 citations identified, 59 studies that evaluated over 112 host biomarkers were selected. Most studies involved patient populations from high-income countries, while 19% involved populations from low- and middle-income countries. The most frequently evaluated host biomarkers were C-reactive protein (61%), white blood cell count (44%) and procalcitonin (34%). Study quality scores ranged from 23.1% to 92.3%. There were 9 high performance host biomarkers or combinations, with sensitivity and specificity of ≥85% or either sensitivity or specificity was reported to be 100%. Five host biomarkers were considered weak markers as they lacked statistically significant performance in discriminating between bacterial and non-bacterial infections. Discussion This manuscript provides a summary of host biomarkers to differentiate bacterial from non-bacterial infections in patients with acute febrile illness. Findings provide a basis for prioritizing efforts for further research, assay development and eventual commercialization of rapid point-of-care tests to guide use of antimicrobials. This review also highlights gaps in current knowledge that should be addressed to further improve management of febrile patients.
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Affiliation(s)
- Anokhi J. Kapasi
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Iveth J. González
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
| | - Timothy C. Rodwell
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech Building B2 Level 0, 9 Chemin des Mines, 1202, Geneva, Switzerland
- * E-mail:
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20
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van de Geijn GJM, Denker S, Meuleman-van Waning V, Koeleman HGM, Birnie E, Braunstahl GJ, Njo TL. Evaluation of new laboratory tests to discriminate bacterial from nonbacterial chronic obstructive pulmonary disease exacerbations. Int J Lab Hematol 2016; 38:616-628. [PMID: 27459873 DOI: 10.1111/ijlh.12550] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 06/03/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTIONS Discriminating bacterial from nonbacterial acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is difficult, causing antibiotics overuse and bacterial resistance. Sputum cultures are of limited use because results take time. In our hospital, only leukocyte concentration and CRP are laboratory parameters evaluated in AECOPD. We evaluated additional tests to discriminate bacterial vs. nonbacterial AECOPD: 5-part leukocyte differentiation (hematology analyzer), leukocyte differentiation using flow cytometry (Leukoflow, Cytodiff), Leuko64 kit, and procalcitonin. METHODS Retrospectively, patients were classified as bacterial or nonbacterial AECOPD. ROC analyses tested how the additional tests discriminate these groups. RESULTS Twenty-two AECOPD were classified as bacterial and 23 as nonbacterial. From the additional tests, basophil percentage (Cytodiff) has superior AUC (0.800). At a cutoff resulting in ≥90% sensitivity, neutrophil/lymphocyte ratio (AUC:0.755) and CD4-positive T cells (Leukoflow, AUC:0.747) have the highest specificity (57%). Both neutrophil mean volume and standard deviation (Cell Population Data, DxH800 hematology analyzer) had good combined sensitivity and specificity (AUC:0.846/0.804, 91% sensitivity, 69% specificity). Addition of leukocyte populations and procalcitonin to CRP in regression models (AUC: 0.907/0.876/0.890) increased specificity compared to CRP alone (71% or 73% vs. 39%). CONCLUSION No additional test has sufficient accuracy on its own to predict bacterial AECOPD. Combining CRP with several parameters from the additional tests may improve this.
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Affiliation(s)
- G-J M van de Geijn
- Department of Clinical Chemistry (KCHL), Franciscus Gasthuis, Rotterdam, The Netherlands
| | - S Denker
- Department of Pulmonology/Internal Medicine, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - V Meuleman-van Waning
- Department of Pulmonology/Internal Medicine, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - H G M Koeleman
- Department of Microbiology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - E Birnie
- Department of Statistics and Education, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - G-J Braunstahl
- Department of Pulmonology/Internal Medicine, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - T L Njo
- Department of Clinical Chemistry (KCHL), Franciscus Gasthuis, Rotterdam, The Netherlands
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Chen YWR, Leung JM, Sin DD. A Systematic Review of Diagnostic Biomarkers of COPD Exacerbation. PLoS One 2016; 11:e0158843. [PMID: 27434033 PMCID: PMC4951145 DOI: 10.1371/journal.pone.0158843] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/22/2016] [Indexed: 01/03/2023] Open
Abstract
The aims of this systematic review were to determine which blood-based molecules have been evaluated as possible biomarkers to diagnose chronic obstructive pulmonary disease (COPD) exacerbations (AECOPD) and to ascertain the quality of these biomarker publications. Patients of interest were those that have been diagnosed with COPD. MEDLINE, EMBASE, and CINAHL databases were searched systematically through February 2015 for publications relating to AECOPD diagnostic biomarkers. We used a modified guideline for the REporting of tumor MARKer Studies (mREMARK) to assess study quality. Additional components of quality included the reporting of findings in a replication cohort and the use of receiver-operating characteristics area-under-the curve statistics in evaluating performance. 59 studies were included, in which the most studied biomarkers were C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). CRP showed consistent elevations in AECOPD compared to control subjects, while IL-6 and TNF-α had variable statistical significance and results. mREMARK scores ranged from 6 to 18 (median score of 13). 12 articles reported ROC analyses and only one study employed a replication cohort to confirm biomarker performance. Studies of AECOPD diagnostic biomarkers remain inconsistent in their reporting, with few studies employing ROC analyses and even fewer demonstrating replication in independent cohorts.
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Affiliation(s)
- Yu-Wei Roy Chen
- Centre for Heart Lung Innovation, Institute for Heart Lung Health at St. Paul’s Hospital & Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janice M. Leung
- Centre for Heart Lung Innovation, Institute for Heart Lung Health at St. Paul’s Hospital & Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Don D. Sin
- Centre for Heart Lung Innovation, Institute for Heart Lung Health at St. Paul’s Hospital & Department of Medicine, Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
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Lin C, Pang Q. Meta-analysis and systematic review of procalcitonin-guided treatment in acute exacerbation of chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2016; 12:10-15. [PMID: 27328801 DOI: 10.1111/crj.12519] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/18/2016] [Accepted: 06/18/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To evaluate the method of procalcitonin (PCT)-guided treatment on antibiotics in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS Database including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trails were searched to find relevant trails. Randomized and quasi-randomized trials of PCT-guided treatment in adult patients with AECOPD were included. Effects on primary outcome (i.e., antibiotic prescriptions, mortality, and clinical success) were accessed in this meta-analysis. RESULTS Four trials involving 679 patients were included. PCT-guided treatment significantly reduced antibiotic use (OR 0.26, 95% CI 0.14-0.50, P < 0.0001) in comparison to standard treatment, without increasing clinical failure (OR 1.10, 95% CI 0.70-1.74, P = 0.68; I2 = 0%) and mortality (OR 0.86, 95% CI 0.44-1.68, P = 0.66). The rate of readmission and exacerbation at follow-up period was similar in both groups. CONCLUSION Results from this meta-analysis suggest PCT-guided treatment can safely reduce antibiotic overuse in patients with AECOPD.
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Affiliation(s)
- Changyang Lin
- Department of Gerontology, Guizhou provincial people's hospital, Guiyang, China
| | - Qiyuan Pang
- Department of Gerontology, Guizhou provincial people's hospital, Guiyang, China
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Abers MS, Sandvall BP, Sampath R, Zuno C, Uy N, Yu VL, Stager CE, Musher DM. Postobstructive Pneumonia: An Underdescribed Syndrome. Clin Infect Dis 2016; 62:957-61. [PMID: 26908806 PMCID: PMC4803103 DOI: 10.1093/cid/civ1212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Postobstructive community-acquired pneumonia (PO-CAP) is relatively common in clinical practice. The clinical syndrome is poorly defined, and the role of infection as a cause of the infiltrate is uncertain. We prospectively studied patients with PO-CAP and compared them to a cohort of patients with bacterial community-acquired pneumonia (B-CAP). Methods. We prospectively studied patients hospitalized for CAP; 5.4% had PO-CAP, defined as a pulmonary infiltrate occurring distal to an obstructed bronchus. Sputum and blood cultures, viral polymerase chain reaction, urinary antigen tests, and serum procalcitonin (PCT) were done in nearly all cases. Clinical and laboratory characteristics of patients with PO-CAP were compared to those of patients with B-CAP. Results. In a 2-year period, we identified 30 patients with PO-CAP. Compared to patients with B-CAP, patients with PO-CAP had longer duration of symptoms (median, 14 vs 5 days; P < .001). Weight loss and cavitary lesions were more common (P < .01 for both comparisons) and leukocytosis was less common (P < .01) in patients with PO-CAP. A bacterial pathogen was implicated in only 3 (10%) PO-CAP cases. PCT was <0.25 ng/mL in 19 (63.3%) patients. Although no differences were observed in disease severity or rates of intensive care unit admissions, 30-day mortality was significantly higher in PO-CAP vs B-CAP (40.0% vs 11.7%; P < .01). Conclusions. Although there is substantial overlap, PO-CAP is a clinical entity distinct from B-CAP; a bacterial cause was identified in only 10% of patients. Our study has important implications for the clinical recognition of patients with PO-CAP, the role of microorganisms as etiologic agents, and the use of antibiotic therapy.
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Affiliation(s)
- Michael S Abers
- Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts
| | - Barcleigh P Sandvall
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California
| | - Rahul Sampath
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Carlo Zuno
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Natalie Uy
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Victor L Yu
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Charles E Stager
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Daniel M Musher
- Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center Department of Medicine and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
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Lopez-Campos JL, Calero-Acuña C, Lopez-Ramirez C, Abad-Arranz M, Márquez-Martín E, Ortega-Ruiz F, Arellano E. Implications of the inflammatory response for the identification of biomarkers of chronic obstructive pulmonary disease. Biomark Med 2016; 10:109-22. [PMID: 26808692 DOI: 10.2217/bmm.15.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by both local and systemic inflammation. Because inflammation plays a critical role in the development, course and severity of COPD, inflammatory markers have the potential to improve the current diagnostic and prognostic approaches. Local inflammation in COPD is characterized by an infiltration of inflammatory cells, with an increased expression of cytokines, chemokines, enzymes, growth factors and adhesion molecules. Systemic low-grade inflammation is another common but nonspecific finding in COPD. Exacerbations of COPD are acute clinical events accompanied by an exaggerated inflammatory response. Future investigations in the field of COPD biomarkers should take into account different study designs and biochemical assays, disease course and duration, variations in symptom severity and timing of measurement.
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Affiliation(s)
- Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Calero-Acuña
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Cecilia Lopez-Ramirez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - María Abad-Arranz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Eduardo Márquez-Martín
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Francisco Ortega-Ruiz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Arellano
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
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Gelfer G, Leggett J, Myers J, Wang L, Gilbert DN. The clinical impact of the detection of potential etiologic pathogens of community-acquired pneumonia. Diagn Microbiol Infect Dis 2015; 83:400-6. [PMID: 26341706 PMCID: PMC7125660 DOI: 10.1016/j.diagmicrobio.2015.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/28/2015] [Accepted: 08/02/2015] [Indexed: 01/09/2023]
Abstract
The etiology of community-acquired pneumonia (CAP) is determined in less than half of the patients based on cultures of sputum and blood plus testing urine for the antigens of Streptococcus pneumoniae and Legionella pneumophila. This study added nasal polymerase chain reaction (PCR) probes for S. pneumoniae, Staphylococcus aureus, and respiratory viruses. Serum procalcitonin (PCT) levels were measured. Pathogens were identified in 78% of the patients. For detection of viruses, patients were randomized to either a 5-virus laboratory-generated PCR bundle or the 17-virus FilmArray PCR platform. The FilmArray PCR platform detected more viruses than the laboratory-generated bundle and did so in less than 2 hours. There were fewer days of antibiotic therapy, P = 0.003, in CAP patients with viral infections and a low serum PCT levels.
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Affiliation(s)
- Gita Gelfer
- Providence Portland Medical Center, Portland, OR, USA
| | - James Leggett
- Providence Portland Medical Center, Portland, OR, USA
| | - Jillian Myers
- Providence Portland Medical Center, Portland, OR, USA
| | - Luan Wang
- Providence Portland Medical Center, Portland, OR, USA
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Timbrook T, Maxam M, Bosso J. Antibiotic Discontinuation Rates Associated with Positive Respiratory Viral Panel and Low Procalcitonin Results in Proven or Suspected Respiratory Infections. Infect Dis Ther 2015; 4:297-306. [PMID: 26342921 PMCID: PMC4575297 DOI: 10.1007/s40121-015-0087-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The differentiation of viral from bacterial pneumonia is important in determining whether antibiotics are appropriate for treatment of these infections. Advances in diagnostic technologies such as respiratory panels (RP) utilizing polymerase chain reactions to detect viruses and determination of procalcitonin (PCT) concentrations may aid in this differentiation. However, some studies have shown limited impact for this purpose and thus continuation of antibiotics despite results suggesting viral infection. Our objective was to characterize clinician-prescribing behavior at our institution once RP and/or PCT results were known and suggestive of a viral respiratory infection. METHODS This retrospective analysis was based upon records of hospitalized patients in whom proven or possible respiratory infections as indicated by RP testing, respiratory bacterial culture or International Statistical Classification of Diseases and Related Health Problems 9th revision codes for acute infectious respiratory illness was documented. Patients evaluated were required to have a RP or PCT within the first 72 h of presentation. Drug orders were evaluated for discontinuation of antibiotic therapy within 48 h of a procalcitonin of <0.25 μg/mL, a positive viral RP result, or both. RESULTS Of 4869 patients with PCT and/or RP results, 2031 were included. PCT and RP testing were obtained in 503 and 1823 patients, respectively, with 295 patients having both. Results of these tests suggested 789 patients were potential candidates for antibiotic avoidance. These included 219 with a PCT <0.25 μg/mL, 601 with a positive viral RP result, and 31 with both. Antibiotics were administered to 307 patients (39%) within the first 72 h. In these, antibiotics were discontinued within 48 h of laboratory results availability. CONCLUSION These results suggest that positive viral RP and low PCT results are infrequently associated with discontinuation of antibiotic therapy in proven or possible respiratory infections at our institution. Direct interventions with clinicians are likely needed to correct this behavior and decrease unnecessary antibiotic use.
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Affiliation(s)
- Tristan Timbrook
- Department of Pharmacy Services, Medical University of South Carolina Hospital, Charleston, SC, USA.,Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, SC, USA
| | - Meshell Maxam
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, SC, USA
| | - John Bosso
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, SC, USA. .,Division of Infectious Diseases, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Lopez-Campos JL, Agustí A. Heterogeneity of chronic obstructive pulmonary disease exacerbations: a two-axes classification proposal. THE LANCET RESPIRATORY MEDICINE 2015; 3:729-734. [PMID: 26165134 DOI: 10.1016/s2213-2600(15)00242-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/29/2015] [Accepted: 06/04/2015] [Indexed: 12/24/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are clinically relevant events with therapeutic and prognostic implications. Yet, they are heterogeneous and can need different therapeutic strategies. In this Viewpoint, we propose an admittedly crude approach to a COPD exacerbation classification that might eventually help to define the most appropriate pharmacological treatment and clinical treatment setting for these patients. Our suggestion is to combine a pathobiological axis (biomarkers) to guide treatment decisions (use of antibiotics, steroids, or both) with a clinical axis (severity score) to decide the organisational context in which to optimally treat the patient. Needless to say, this proposal needs to be researched and eventually validated, refined, or disproved, but we hope that this process will contribute to the improvement of personalised treatment for patients with COPD exacerbations.
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Affiliation(s)
- Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Seville, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Alvar Agustí
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Gilbert DN. Where Do We Go From Here? J Infect Dis 2015; 212:1687-9. [PMID: 25910631 DOI: 10.1093/infdis/jiv253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- David N Gilbert
- Department of Infectious Diseases, Providence Portland Medical Center, Oregon
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Chang CH, Tsao KC, Hu HC, Huang CC, Kao KC, Chen NH, Yang CT, Tsai YH, Hsieh MJ. Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits. Int J Chron Obstruct Pulmon Dis 2015; 10:767-74. [PMID: 25926728 PMCID: PMC4403815 DOI: 10.2147/copd.s76740] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Viral and bacterial infections are the most common causes of chronic obstructive pulmonary disease (COPD) exacerbations. Whether serum inflammatory markers can differentiate bacterial from virus infection in patients with COPD exacerbation requiring emergency department (ED) visits remains controversial. Methods Viral culture and polymerase chain reaction (PCR) were used to identify the viruses in the oropharynx of patients with COPD exacerbations. The bacteria were identified by the semiquantitative culture of the expectorated sputum. The peripheral blood white blood cell (WBC) counts, serum C-reactive protein (CRP), procalcitonin (PCT), and clinical symptoms were compared among patients with different types of infections. Results Viruses were isolated from 16 (22.2%) of the 72 patients enrolled. The most commonly identified viruses were parainfluenza type 3, influenza A, and rhinovirus. A total of 30 (41.7%) patients had positive bacterial cultures, with the most commonly found bacteria being Haemophilus influenzae and Haemophilus parainfluenzae. Five patients (6.9%) had both positive sputum cultures and virus identification. The WBC, CRP, and PCT levels of the bacteria-positive and bacteria-negative groups were not statistically different. Multivariate analysis showed that patients with increased sputum volumes during the COPD exacerbations had higher risks of recurrent exacerbations in the 1-year period following the first exacerbation. Conclusion WBC, CRP, or PCT could not differentiate between bacterial and viral infections in patients with COPD exacerbation requiring ED visits. Those with increased sputum during a COPD exacerbation had higher risks for recurrent exacerbations.
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Affiliation(s)
- Chih-Hao Chang
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan ; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Han-Chung Hu
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan
| | - Chung-Chi Huang
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan
| | - Ning-Hung Chen
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan
| | - Ying-Huang Tsai
- Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan ; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Puzi City, Taiwan
| | - Meng-Jer Hsieh
- Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan ; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Puzi City, Taiwan
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Hoshina T, Nanishi E, Kanno S, Nishio H, Kusuhara K, Hara T. The utility of biomarkers in differentiating bacterial from non-bacterial lower respiratory tract infection in hospitalized children: Difference of the diagnostic performance between acute pneumonia and bronchitis. J Infect Chemother 2014; 20:616-20. [DOI: 10.1016/j.jiac.2014.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/27/2014] [Accepted: 06/07/2014] [Indexed: 11/29/2022]
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Stockley RA. Biomarkers in chronic obstructive pulmonary disease: confusing or useful? Int J Chron Obstruct Pulmon Dis 2014; 9:163-77. [PMID: 24532968 PMCID: PMC3923613 DOI: 10.2147/copd.s42362] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The field of biomarker research has almost reached unmanageable proportions in chronic obstructive pulmonary disease (COPD). The developments of new technology platforms have generated a huge information data base, both cross sectionally and increasingly, longitudinally. The knowledge emerging provides an enormous potential for understanding the disease pathophysiology, for developing markers specific for long-term outcomes, and for developing new therapeutic strategies. However, the excitement must be tempered with an understanding of the limitations of the data collection techniques, and of the variations in disease state, activity, impact, and progression. Nevertheless, the most crucial aspect in interpreting the current literature is the recognition of the relatively superficial characterization of what is a complex group of pathological processes with a common end point of airflow limitation. The current review explores some of these issues together with those areas where real progress appears to have been made, and provides caution on interpretation.
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Affiliation(s)
- Robert A Stockley
- Queen Elizabeth Hospital Birmingham, Lung Function and Sleep Department, Birmingham, UK
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Huerta A, Crisafulli E, Menéndez R, Martínez R, Soler N, Guerrero M, Montull B, Torres A. Pneumonic and nonpneumonic exacerbations of COPD: inflammatory response and clinical characteristics. Chest 2014; 144:1134-1142. [PMID: 23828375 DOI: 10.1378/chest.13-0488] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a frequent event in patients with COPD, although it is not currently considered an acute exacerbation of COPD (AECOPD). To our knowledge, no studies have compared the inflammatory response of patients with COPD who develop CAP or AECOPD. The aim of our study was to compare clinical and evolutive manifestations and biologic signaling of AECOPD and CAP + COPD. METHODS Prospective data were collected from 249 consecutively hospitalized patients with COPD. Comparative analyses were performed in patients with AECOPD (n = 133) and patients with CAP + COPD (n = 116). Measures of clinical characteristics, blood biomarkers, and evolution were recorded on admission, after 3 and 30 days, and in a follow-up period of 30 days, 90 days, and 1 year. RESULTS Patients with CAP + COPD had higher FEV1 compared with patients with COPD without pneumonia. In-hospital and long-term outcomes (1 year) were similar for both populations. However, patients with AECOPD had more readmissions, and patients with CAP had more prior episodes of pneumonia. At day 1 and day 3, patients with CAP + COPD had significantly (P < .001) higher serum levels of C-reactive protein (CRP), procalcitonin, tumor necrosis factor-α, and IL-6. Repetition of the analyses after stratifying patients based on severity of disease, current inhaled pharmacotherapy, and noninfectious AECOPD cause confirmed higher levels of the same biomarkers in patients with CAP + COPD. Chills, pleuritic pain, sputum purulence, and CRP levels at day 1 were independent clinical predictors of CAP + COPD. CONCLUSIONS Our study confirms that two different clinical and inflammatory profiles exist in hospitalized patients with COPD in response to CAP (stronger response) and AECOPD, although with similar short-term and long-term outcomes.
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Affiliation(s)
- Arturo Huerta
- Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain
| | - Ernesto Crisafulli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rosario Menéndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain
| | - Raquel Martínez
- Pneumology Department, Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain
| | - Néstor Soler
- Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain
| | - Mónica Guerrero
- Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain
| | - Beatriz Montull
- Pneumology Department, Hospital Universitario y Politécnico La Fe, CIBERES, Valencia, Spain
| | - Antoni Torres
- Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, CIBERES 06/06/0028, Spain.
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Falsey AR, Becker KL, Swinburne AJ, Nylen ES, Formica MA, Hennessey PA, Criddle MM, Peterson DR, Baran A, Walsh EE. Bacterial complications of respiratory tract viral illness: a comprehensive evaluation. J Infect Dis 2013; 208:432-41. [PMID: 23661797 PMCID: PMC3699009 DOI: 10.1093/infdis/jit190] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background. Respiratory tract infection is one of the most common reasons for hospitalization among adults, and recent evidence suggests that many of these illnesses are associated with viruses. Although bacterial infection is known to complicate viral infections, the frequency and impact of mixed viral-bacterial infections has not been well studied. Methods. Adults hospitalized with respiratory illness during 3 winters underwent comprehensive viral and bacterial testing. This assessment was augmented by measuring the serum level of procalcitonin (PCT) as a marker of bacterial infection. Mixed viral-bacterial infection was defined as a positive viral test result plus a positive bacterial assay result or a serum PCT level of ≥ 0.25 ng/mL on admission or day 2 of hospitalization. Results. Of 842 hospitalizations (771 patients) evaluated, 348 (41%) had evidence of viral infection. A total of 212 hospitalizations (61%) involved patients with viral infection alone. Of the remaining 136 hospitalizations (39%) involving viral infection, results of bacterial tests were positive in 64 (18%), and PCT analysis identified bacterial infection in an additional 72 (21%). Subjects hospitalized with mixed viral-bacterial infections were older and more commonly received a diagnosis of pneumonia. Over 90% of hospitalizations in both groups involved subjects who received antibiotics. Notably, 4 of 10 deaths among subjects hospitalized with viral infection alone were secondary to complications of Clostridium difficile colitis. Conclusions. Bacterial coinfection is associated with approximately 40% of viral respiratory tract infections requiring hospitalization. Patients with positive results of viral tests should be carefully evaluated for concomitant bacterial infection. Early empirical antibiotic therapy for patients with an unstable condition is appropriate but is not without risk.
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