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      International Journal of COPD (submit here)

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      Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease

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          Abstract

          Objective:

          The identification of biological markers in order to assess different aspects of COPD is an area of growing interest. The objective of this study was to investigate whether levels of procalcitonin (PCT), C-reactive protein (CRP), and neopterin in COPD patients could be useful in identifying the etiological origin of the exacerbation and assessing its prognosis.

          Methods:

          We included 318 consecutive COPD patients: 46 in a stable phase, 217 undergoing an exacerbation, and 55 with pneumonia. A serum sample was collected from each patient at the time of being included in the study. A second sample was also collected 1 month later from 23 patients in the exacerbation group. We compared the characteristics, biomarker levels, microbiological findings, and prognosis in each patient group. PCT and CRP were measured using an immunofluorescence assay. Neopterin levels were measured using a competitive immunoassay.

          Results:

          PCT and CRP showed significant differences among the three patient groups, being higher in patients with pneumonia, followed by patients with exacerbation ( P < 0.0001). For the 23 patients with paired samples, PCT and CRP levels decreased 1 month after the exacerbation episode, while neopterin increased. Neopterin showed significantly lower levels in exacerbations with isolation of pathogenic bacteria, but no differences were found for PCT and CRP. No significant differences were found when comparing biomarker levels according to the Gram result: PCT ( P = 0.191), CRP ( P = 0.080), and neopterin ( P = 0.109). However, median values of PCT and CRP were high for Streptococcus pneumoniae, Staphylococcus aureus, and enterobacteria. All biomarkers were higher in patients who died within 1 month after the sample collection than in patients who died later on.

          Conclusions:

          According to our results, biomarker levels vary depending on the clinical status. However, the identification of the etiology of infectious exacerbation by means of circulating biomarkers is encouraging, but its main disadvantage is the absence of a microbiological gold standard, to definitively demonstrate their value. High biomarker levels during an exacerbation episode correlate with the short-term prognosis, and therefore their measurement can be useful for COPD management.

          Most cited references10

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          Detection of Streptococcus pneumoniae antigen by a rapid immunochromatographic assay in urine samples.

          Evaluation of a newly available rapid (15 min) immunochromatographic membrane test (ICT) to detect Streptococcus pneumoniae in urine samples, in order to assess its utility in the diagnosis of bacteremic and nonbacteremic pneumococcal pneumonia. Retrospective study. We studied urine samples from 51 patients with bacteremic and nonbacteremic pneumonia due to S pneumoniae diagnosed by blood culture and pneumococcal polysaccharide capsular antigen detection by counterimmunoelectrophoresis in urine samples, 16 patients with probable pneumococcal pneumonia, 71 patients with nonpneumococcal pneumonia, and 16 patients with pneumonia but no pathogen identified. Urine samples were collected and frozen at - 20 degrees C until used. The ICT test was performed following the instructions of the manufacturer. S. pneumoniae antigen was detected in 41 of 51 patients with pneumococcal pneumonia (80.4%); results were positive in 23 of 28 bacteremic cases (82.1%) and in 18 of 23 nonbacteremic cases (78.3%). From patients with a diagnosis of presumptive pneumococcal pneumonia, antigen was detected in seven urine samples (43.7%) and also in one case of the 16 patients with pneumonia but no pathogen identified. The specificity of the ICT test was 97.2%. The ICT assay is a valuable tool for the diagnosis of pneumococcal pneumonia, especially for the nonbacteremic cases.
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            Value of serum procalcitonin, neopterin, and C-reactive protein in differentiating bacterial from viral etiologies in patients presenting with lower respiratory tract infections.

            The values of procalcitonin (PCT), neopterin, and C-reactive protein (CRP) alone and in combination to differentiate bacterial from viral etiology in patients with lower respiratory tract infections (LRTIs) were evaluated. Sera obtained on the day of hospitalization for LRTI from 139 patients with confirmed bacterial etiology and 128 patients with viral etiology were examined. A further 146 sera from healthy Chinese subjects with no infection were included as controls. The area under the receiver operating characteristic (ROC) curve (area under curve [AUC]) for distinguishing bacterial from viral infections was 0.838 for CRP and 0.770 for PCT (P < 0.05). The AUC for distinguishing viral from bacterial infections was 0.832 for neopterin (P < 0.05). When the markers were used in combination, AUC of ROC (CRP/neopterin) was 0.857, whereas (CRP x PCT)/neopterin was 0.856. Combination of 2 or all 3 of the biomarkers may improve the discriminatory power in delineating bacterial versus viral etiology in LRTI.
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              C-reactive protein--can it be used as a marker of infection in patients with exacerbation of chronic obstructive pulmonary disease?

              Far from all patients with exacerbation of chronic obstructive pulmonary disease (COPD) benefit from antibiotic treatment. However, as these patients are often colonized with bacteria, even in a stable phase, there is no reliable method for establishing whether the patients have a significant bacterial infection and would benefit from antibiotic treatment. C-reactive protein (CRP) has proven to be useful as a marker of bacterial infection. The aim of this study was to assess to what degree CRP is elevated in patients with exacerbation of COPD. A total of 166 consecutive patients admitted to a department of internal medicine at a university hospital in Copenhagen due to exacerbation of COPD were prospectively included in the study. Patients were asked whether they had experienced increased sputum purulence and whether they were on steroid treatment or not. Blood was drawn for determination of white blood cell count and CRP, and a chest X-ray was taken. Patients whose X-rays of the thorax showed changes compatible with pneumonia were considered to have pneumonia of bacterial origin. Pneumonia was diagnosed in 51 patients. Their median CRP was 97 mg/l (49-145 interquartile range). Among patients without pneumonia, 46% (51/115) had normal CRP values (0-10 mg/l); 64 had no increased sputum purulence and a median CRP of 8 mg/l (2.9-16 mg/l), which is significantly lower than in the 51 patients who reported increased sputum purulence and had a CRP of 45 mg/l (8.5-86 mg/l; p<0.001). CRP values are normal in nearly 50% of patients admitted due to exacerbation of COPD. In patients who have increased sputum purulence, the pattern of increase in CRP is similar to that seen in patients with pneumonia. This suggests that CRP may be used as a marker of significant bacterial infection. Thus, it may be used when deciding whether or not to start antibiotic treatment. This should be tested in a controlled trial.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2011
                2011
                28 February 2011
                : 6
                : 157-169
                Affiliations
                [1 ]Servei de Microbiologia
                [2 ]Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain;
                [3 ]Servei de Pneumologia, Hospital de Sant Boi, Sant Boi de Llobregat, Spain;
                [4 ]CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
                Author notes
                Correspondence: J Domínguez, Servei de Microbiologia, Fundació, Institut en Ciències de la Salut, Germans Trias i Pujol, Carretera del, Canyet s/n, 08916 Badalona, Spain, Tel +34 93 497 88 94, Fax +34 93 497 88 95, Email jadomb@ 123456gmail.com
                Article
                copd-6-157
                10.2147/COPD.S16070
                3064422
                21468168
                923e6ae9-3dc2-456d-8827-68d2e4d9e2cd
                © 2011 Lacoma 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.

                History
                : 25 February 2011
                Categories
                Original Research

                Respiratory medicine
                neopterin,c-reactive protein,procalcitonin,exacerbation,prognosis
                Respiratory medicine
                neopterin, c-reactive protein, procalcitonin, exacerbation, prognosis

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