Chest
Original ResearchCOPDProcalcitonin vs C-Reactive Protein as Predictive Markers of Response to Antibiotic Therapy in Acute Exacerbations of COPD
Section snippets
Materials and Methods
The methods, design, and outcomes of the above-mentioned trial have been described previously in detail.14 In short, 265 exacerbations from 223 patients were enrolled between August 2002 and February 2008 into a randomized placebo-controlled trial investigating the efficacy of doxycycline in addition to systemic corticosteroids for treatment of AECOPD. The study population consisted of patients ≥ 45 years of age, diagnosed with COPD (Global Initiative for Chronic Obstructive Lung Disease stages
Baseline Characteristics
In the original randomized trial, 265 exacerbations were enrolled. The per-protocol group of this trial, consisting of 258 patients, was used for the current study. Fifteen patients were excluded because no serum samples were stored, which made assessment of PCT levels impossible (Fig 1). We evaluated 243 exacerbations from 205 patients. Ninety-five were assigned to doxycycline and 110 to placebo. Table 1 shows the baseline characteristics, which are similar to the original trial.14 A potential
Discussion
To the best of our knowledge, the current study is the first to assess the value of PCT and CRP as markers of bacterial presence, clinical outcome, and efficacy of antibiotics and it has revealed four important new findings. First, we found only a moderate correlation between PCT and CRP in AECOPD. Importantly, most patients with a PCT level of < 0.1 μg/L had an elevated CRP value, in many cases (27%) even exceeding 50 mg/L. Second, we found that CRP was associated with bacterial presence,
Conclusions
In conclusion, CRP and PCT in AECOPD are only moderately correlated, and CRP is associated with airway bacterial presence, whereas PCT is not. Furthermore, although antibiotic therapy in patients with low PCT levels could be discouraged based on the literature, the current study suggests a benefit. This challenges the role of PCT as a predictive marker in AECOPD. Patients with a CRP of ≤ 5 mg/L have a favorable outcome regardless of antibiotic therapy, whereas patients with a CRP > 50 mg/L show
Acknowledgments
Author contributions: Dr Daniels: contributed to data collection, analysis and interpretation of the data, and manuscript preparation.
Ms Schoorl: contributed to data collection, analysis and interpretation of the data, and manuscript preparation.
Dr Snijders: contributed to data collection, analysis and interpretation of the data, and manuscript preparation.
Dr Knol: contributed to statistical analysis.
Dr Lutter: contributed to interpretation of the data and critical revision of the manuscript.
Dr
References (25)
- et al.
Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy
Chest
(2007) - et al.
C-reactive protein—can it be used as a marker of infection in patients with exacerbation of chronic obstructive pulmonary disease?
Eur J Intern Med
(2006) - et al.
Value of C-reactive protein measurements in exacerbations of chronic obstructive pulmonary disease
Respir Med
(1998) - et al.
Management of acute exacerbations of COPD: a summary and appraisal of published evidence
Chest
(2001) - et al.
Evaluation of an algorithm for switching from IV to PO therapy in clinical practice in patients with community-acquired pneumonia
Clin Ther
(2004) - et al.
Evidence-based health policy—lessons from the Global Burden of Disease Study
Science
(1996) - et al.
Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease
Am J Respir Crit Care Med
(2000) - et al.
Natural History of Chronic Bronchitis and Emphysema
(1976) - et al.
Chronic obstructive pulmonary disease. 6: the aetiology of exacerbations of chronic obstructive pulmonary disease
Thorax
(2003) - et al.
Antibiotics for exacerbations of chronic obstructive pulmonary disease
Cochrane Database Syst Rev
(2006)
Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease
Ann Intern Med
WHO Report on Infectious Disease: Overcoming Antimicrobial Resistance
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Funding/Support: This study was supported by an unrestricted grant from GlaxoSmithKline (The Netherlands).
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