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      Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note

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          Abstract

          Background

          Serum procalcitonin levels have been used as a biomarker of invasive bacterial infection and recently have been advocated to guide antibiotic therapy in patients with chronic obstructive pulmonary disease (COPD). However, rigorous studies correlating procalcitonin levels with microbiologic data are lacking. Acute exacerbations of COPD (AECOPD) have been linked to viral and bacterial infection as well as noninfectious causes. Therefore, we evaluated procalcitonin as a predictor of viral versus bacterial infection in patients hospitalized with AECOPD with and without evidence of pneumonia.

          Methods

          Adults hospitalized during the winter with symptoms consistent with AECOPD underwent extensive testing for viral, bacterial, and atypical pathogens. Serum procalcitonin levels were measured on day 1 (admission), day 2, and at one month. Clinical and laboratory features of subjects with viral and bacterial diagnoses were compared.

          Results

          In total, 224 subjects with COPD were admitted for 240 respiratory illnesses. Of these, 56 had pneumonia and 184 had AECOPD alone. A microbiologic diagnosis was made in 76 (56%) of 134 illnesses with reliable bacteriology (26 viral infection, 29 bacterial infection, and 21 mixed viral bacterial infection). Mean procalcitonin levels were significantly higher in patients with pneumonia compared with AECOPD. However, discrimination between viral and bacterial infection using a 0.25 ng/mL threshold for bacterial infection in patients with AECOPD was poor.

          Conclusion

          Procalcitonin is useful in COPD patients for alerting clinicians to invasive bacterial infections such as pneumonia but it does not distinguish bacterial from viral and noninfectious causes of AECOPD.

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          Author and article information

          Journal
          Int J Chron Obstruct Pulmon Dis
          Int J Chron Obstruct Pulmon Dis
          International Journal of COPD
          International Journal of Chronic Obstructive Pulmonary Disease
          Dove Medical Press
          1176-9106
          1178-2005
          2012
          2012
          23 February 2012
          : 7
          : 127-135
          Affiliations
          [1 ]Department of Medicine, University of Rochester, Rochester, NY
          [2 ]Rochester General Hospital, Rochester, NY
          [3 ]Veterans Affairs Medical Center and George Washington University, Washington DC
          [4 ]Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
          Author notes
          Correspondence: Ann R Falsey, Infectious Disease Unit, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA, Tel +1 585 922 4339, Fax +1 585 922 5168, Email ann.falsey@ 123456rochestergeneral.org
          Article
          copd-7-127
          10.2147/COPD.S29149
          3292390
          22399852
          © 2012 Falsey et al, publisher and licensee Dove Medical Press Ltd.

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

          Categories
          Original Research

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