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Procalcitonin levels in acute exacerbation of COPD admitted in ICU: a prospective cohort study.

Daubin C, Parienti JJ, Vabret A, Ramakers M, Fradin S, Terzi N, Freymuth F, Charbonneau P, du Cheyron D - BMC Infect. Dis. (2008)

Bottom Line: Among the four patients positive for Pseudomonas aeruginosa, one had a PCTmax less than 0.25 microg/L and three had a PCTmax less than 0.1 microg/L.The one patient positive for Haemophilus influenzae had a PCTmax more than 0.25 microg/L.The presence or absence of viruses did not influence PCT at time of admission (0.068 vs 0.098 microg/L respectively, P = 0.80).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Intensive Care, Caen University Hospital, 14033 Caen Cedex, France. daubin-c@chu-caen.fr

ABSTRACT

Background: Antibiotics are recommended for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to intensive care units (ICU). Serum procalcitonin (PCT) could be a useful tool for selecting patients with a lower probability of developing bacterial infection, but its measurement has not been investigated in this population.

Methods: We conducted a single center prospective cohort study in consecutive COPD patients admitted to the ICU for AECOPD between September 2005 and September 2006. Sputum samples or tracheal aspirates were tested for the presence of bacteria and viruses. PCT levels were measured at the time of admittance, six hours, and 24 hours using a sensitive immunoassay.

Results: Thirty nine AECOPD patients were included, 31 of which (79%) required a ventilator support at admission. The median [25%-75% interquartile range] PCT level, assessed in 35/39 patients, was: 0.096 microg/L [IQR, 0.065 to 0.178] at the time of admission, 0.113 microg/L [IQR, 0.074 to 0.548] at six hours, and 0.137 microg/L [IQR, 0.088 to 0.252] at 24 hours. The highest PCT (PCTmax) levels were less than 0.1 microg/L in 14/35 (40%) patients and more than 0.25 microg/L in 10/35 (29%) patients, suggesting low and high probability of bacterial infection, respectively. Five species of bacteria and nine species of viruses were detected in 12/39 (31%) patients. Among the four patients positive for Pseudomonas aeruginosa, one had a PCTmax less than 0.25 microg/L and three had a PCTmax less than 0.1 microg/L. The one patient positive for Haemophilus influenzae had a PCTmax more than 0.25 microg/L. The presence or absence of viruses did not influence PCT at time of admission (0.068 vs 0.098 microg/L respectively, P = 0.80).

Conclusion: The likelihood of bacterial infection is low among COPD patients admitted to ICU for AECOPD (40% with PCT < 0.1 microg/L) suggesting a possible inappropriate use of antibiotics. Further studies are necessary to assess the impact of a procalcitonin-based therapeutic strategy in critically ill COPD patients.

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Box-and-whisker plots representing PCT levels measured at various time. On the horizontal axis, and for each boxplot, the legend corresponds to the time of PCT measurement. On the vertical axis, the number corresponds to the PCT levels (μg/L). Each box denotes the middle 50% of the data measured at that time. The lower and upper ends of the box denote the 25th and 75th percentile, respectively. The solid black horizontal lines through each box denote the median of the distribution. The vertical solid black lines (the "whisker") reach out to the 1.5 interquartile range. Circles above the whisker denote individual external observations.
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Figure 2: Box-and-whisker plots representing PCT levels measured at various time. On the horizontal axis, and for each boxplot, the legend corresponds to the time of PCT measurement. On the vertical axis, the number corresponds to the PCT levels (μg/L). Each box denotes the middle 50% of the data measured at that time. The lower and upper ends of the box denote the 25th and 75th percentile, respectively. The solid black horizontal lines through each box denote the median of the distribution. The vertical solid black lines (the "whisker") reach out to the 1.5 interquartile range. Circles above the whisker denote individual external observations.

Mentions: The circulating levels of procalcitonin are shown in Figure 2. The median [25%–75% interquartile range] procalcitonin levels at admission (PCT-H0) were 0.096 μg/L [0.065–0.178], PCT-H6 was 0.113 μg/L [0.074–0.548], and PCT-H24 was 0.137 μg/L [0.088–0.252]. Procalcitonin levels were not different in patients who had received antibiotics in the month or the 24 hours prior to ICU admission compared to antibiotic-naive patients (PCT-H0 0.071 μg/L [0.056–0.189] vs 0.099 μg/L [0.065–0.178], P = 0.36 and PCT-H0 0.081 μg/L [0.071–0.397] vs 0.103 μg/L [0.062–0.178], P = 0.93, respectively). There was no association between PCT-H0 levels and the presence or absence of sputum (PCT-H0 0.106 μg/L [0.072–0.231] vs 0.085 μg/L [0.062–0.163], P = 0.65, cough (PCT-H0 0.083 μg/L [0.068–0.162] vs 0.103 μg/L [0.062–0.695], P = 0.57, wheezing (PCT-H0 0.083 μg/L [0.057–0.178] vs 0.103 μg/L [0.075–0.695], P = 0.29, and fever (ie temperature > 38°C) (PCT-H0 0.081 μg/L [0.068–0.103] vs 0.098 μg/L [0.059–0.183], P = 0.92). The PCTmax was < 0.1 μg/L in 14/35 patients (40%), between 0.1 and 0.25 μg/L in 11/35 patients (31%), and > 0.25 μg/L in 10/35 patients (29%). There was no association between the PCTmax levels and the severity of COPD (P = 0.07). Patients with PCTmax > 0.25 μg/L were more critically ill: SAPS II 39 [28–40] vs 27 [24–31] among patients with PCTmax ≤ 0.25 μg/L, P = 0.005 ; and LOD 5 [3–8] vs 3 [2–4] among patients with PCTmax ≤ 0.25 μg/L, P = 0.018. The median CRP level at admission (CRP-H0) was 19 mg/L [9–60] and CRP-H24 was 21 mg/L [11–34] and was not significantly higher among those with a PCTmax > 0.25 μg/L (CRP-H0 43 μg/L [11–156] vs 14 [8–24], P = 0.12 and CRP-H24 78 μg/L [11–106] vs 20 [11–26], P = 0.17).


Procalcitonin levels in acute exacerbation of COPD admitted in ICU: a prospective cohort study.

Daubin C, Parienti JJ, Vabret A, Ramakers M, Fradin S, Terzi N, Freymuth F, Charbonneau P, du Cheyron D - BMC Infect. Dis. (2008)

Box-and-whisker plots representing PCT levels measured at various time. On the horizontal axis, and for each boxplot, the legend corresponds to the time of PCT measurement. On the vertical axis, the number corresponds to the PCT levels (μg/L). Each box denotes the middle 50% of the data measured at that time. The lower and upper ends of the box denote the 25th and 75th percentile, respectively. The solid black horizontal lines through each box denote the median of the distribution. The vertical solid black lines (the "whisker") reach out to the 1.5 interquartile range. Circles above the whisker denote individual external observations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2577677&req=5

Figure 2: Box-and-whisker plots representing PCT levels measured at various time. On the horizontal axis, and for each boxplot, the legend corresponds to the time of PCT measurement. On the vertical axis, the number corresponds to the PCT levels (μg/L). Each box denotes the middle 50% of the data measured at that time. The lower and upper ends of the box denote the 25th and 75th percentile, respectively. The solid black horizontal lines through each box denote the median of the distribution. The vertical solid black lines (the "whisker") reach out to the 1.5 interquartile range. Circles above the whisker denote individual external observations.
Mentions: The circulating levels of procalcitonin are shown in Figure 2. The median [25%–75% interquartile range] procalcitonin levels at admission (PCT-H0) were 0.096 μg/L [0.065–0.178], PCT-H6 was 0.113 μg/L [0.074–0.548], and PCT-H24 was 0.137 μg/L [0.088–0.252]. Procalcitonin levels were not different in patients who had received antibiotics in the month or the 24 hours prior to ICU admission compared to antibiotic-naive patients (PCT-H0 0.071 μg/L [0.056–0.189] vs 0.099 μg/L [0.065–0.178], P = 0.36 and PCT-H0 0.081 μg/L [0.071–0.397] vs 0.103 μg/L [0.062–0.178], P = 0.93, respectively). There was no association between PCT-H0 levels and the presence or absence of sputum (PCT-H0 0.106 μg/L [0.072–0.231] vs 0.085 μg/L [0.062–0.163], P = 0.65, cough (PCT-H0 0.083 μg/L [0.068–0.162] vs 0.103 μg/L [0.062–0.695], P = 0.57, wheezing (PCT-H0 0.083 μg/L [0.057–0.178] vs 0.103 μg/L [0.075–0.695], P = 0.29, and fever (ie temperature > 38°C) (PCT-H0 0.081 μg/L [0.068–0.103] vs 0.098 μg/L [0.059–0.183], P = 0.92). The PCTmax was < 0.1 μg/L in 14/35 patients (40%), between 0.1 and 0.25 μg/L in 11/35 patients (31%), and > 0.25 μg/L in 10/35 patients (29%). There was no association between the PCTmax levels and the severity of COPD (P = 0.07). Patients with PCTmax > 0.25 μg/L were more critically ill: SAPS II 39 [28–40] vs 27 [24–31] among patients with PCTmax ≤ 0.25 μg/L, P = 0.005 ; and LOD 5 [3–8] vs 3 [2–4] among patients with PCTmax ≤ 0.25 μg/L, P = 0.018. The median CRP level at admission (CRP-H0) was 19 mg/L [9–60] and CRP-H24 was 21 mg/L [11–34] and was not significantly higher among those with a PCTmax > 0.25 μg/L (CRP-H0 43 μg/L [11–156] vs 14 [8–24], P = 0.12 and CRP-H24 78 μg/L [11–106] vs 20 [11–26], P = 0.17).

Bottom Line: Among the four patients positive for Pseudomonas aeruginosa, one had a PCTmax less than 0.25 microg/L and three had a PCTmax less than 0.1 microg/L.The one patient positive for Haemophilus influenzae had a PCTmax more than 0.25 microg/L.The presence or absence of viruses did not influence PCT at time of admission (0.068 vs 0.098 microg/L respectively, P = 0.80).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Intensive Care, Caen University Hospital, 14033 Caen Cedex, France. daubin-c@chu-caen.fr

ABSTRACT

Background: Antibiotics are recommended for severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to intensive care units (ICU). Serum procalcitonin (PCT) could be a useful tool for selecting patients with a lower probability of developing bacterial infection, but its measurement has not been investigated in this population.

Methods: We conducted a single center prospective cohort study in consecutive COPD patients admitted to the ICU for AECOPD between September 2005 and September 2006. Sputum samples or tracheal aspirates were tested for the presence of bacteria and viruses. PCT levels were measured at the time of admittance, six hours, and 24 hours using a sensitive immunoassay.

Results: Thirty nine AECOPD patients were included, 31 of which (79%) required a ventilator support at admission. The median [25%-75% interquartile range] PCT level, assessed in 35/39 patients, was: 0.096 microg/L [IQR, 0.065 to 0.178] at the time of admission, 0.113 microg/L [IQR, 0.074 to 0.548] at six hours, and 0.137 microg/L [IQR, 0.088 to 0.252] at 24 hours. The highest PCT (PCTmax) levels were less than 0.1 microg/L in 14/35 (40%) patients and more than 0.25 microg/L in 10/35 (29%) patients, suggesting low and high probability of bacterial infection, respectively. Five species of bacteria and nine species of viruses were detected in 12/39 (31%) patients. Among the four patients positive for Pseudomonas aeruginosa, one had a PCTmax less than 0.25 microg/L and three had a PCTmax less than 0.1 microg/L. The one patient positive for Haemophilus influenzae had a PCTmax more than 0.25 microg/L. The presence or absence of viruses did not influence PCT at time of admission (0.068 vs 0.098 microg/L respectively, P = 0.80).

Conclusion: The likelihood of bacterial infection is low among COPD patients admitted to ICU for AECOPD (40% with PCT < 0.1 microg/L) suggesting a possible inappropriate use of antibiotics. Further studies are necessary to assess the impact of a procalcitonin-based therapeutic strategy in critically ill COPD patients.

Show MeSH
Related in: MedlinePlus