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Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits.

Chang CH, Tsao KC, Hu HC, Huang CC, Kao KC, Chen NH, Yang CT, Tsai YH, Hsieh MJ - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: 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.Those with increased sputum during a COPD exacerbation had higher risks for recurrent exacerbations.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan.

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.

No MeSH data available.


Related in: MedlinePlus

Laboratory data on day 1 at the ED in the virus-positive and virus-negative patients.Abbreviations: CRP, C-reactive protein; ED, emergency department; WBC, white blood cell.
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f1-copd-10-767: Laboratory data on day 1 at the ED in the virus-positive and virus-negative patients.Abbreviations: CRP, C-reactive protein; ED, emergency department; WBC, white blood cell.

Mentions: Viruses were detected in the oropharynx of 16 (22.2%) of the 72 patients (Table 2). Parainfluenza virus type 3 (PIV3) was the most commonly detected virus (37.5%), followed by influenza A (Inf A) and human rhinovirus. Both adenovirus and PIV3 were identified in one patient. No influenza B or respiratory syncytial virus (RSV) was found. One patient had simultaneous detection of PIV3 and adenovirus. Patients with or without the confirmed presence of viruses were divided into two groups: 16 patients were virus-positive and 56 patients were virus-negative. There were no significant between-group differences in age, BMI, FEV1, FVC, length of hospital days, or number of exacerbation in the subsequent 1 year. Figure 1 shows the laboratory data at the time of ED admission of the 72 COPD exacerbation patients. WBC counts, CRP, and PCT levels were not significantly different between the virus-positive and virus-negative group. A larger proportion of the virus-positive patients had been previously treated with oral corticosteroids than had the virus-negative patients (37.5% versus 14.3%) (P=0.039). The viral-positive groups presented with more sore throat symptoms than did the viral-negative groups (62.5% versus 33.9%) (P=0.04). The family cluster of common cold symptoms was significantly higher for viral-positive groups than viral-negative groups (25% versus 1.8%) (P=0.001).


Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits.

Chang CH, Tsao KC, Hu HC, Huang CC, Kao KC, Chen NH, Yang CT, Tsai YH, Hsieh MJ - Int J Chron Obstruct Pulmon Dis (2015)

Laboratory data on day 1 at the ED in the virus-positive and virus-negative patients.Abbreviations: CRP, C-reactive protein; ED, emergency department; WBC, white blood cell.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4403815&req=5

f1-copd-10-767: Laboratory data on day 1 at the ED in the virus-positive and virus-negative patients.Abbreviations: CRP, C-reactive protein; ED, emergency department; WBC, white blood cell.
Mentions: Viruses were detected in the oropharynx of 16 (22.2%) of the 72 patients (Table 2). Parainfluenza virus type 3 (PIV3) was the most commonly detected virus (37.5%), followed by influenza A (Inf A) and human rhinovirus. Both adenovirus and PIV3 were identified in one patient. No influenza B or respiratory syncytial virus (RSV) was found. One patient had simultaneous detection of PIV3 and adenovirus. Patients with or without the confirmed presence of viruses were divided into two groups: 16 patients were virus-positive and 56 patients were virus-negative. There were no significant between-group differences in age, BMI, FEV1, FVC, length of hospital days, or number of exacerbation in the subsequent 1 year. Figure 1 shows the laboratory data at the time of ED admission of the 72 COPD exacerbation patients. WBC counts, CRP, and PCT levels were not significantly different between the virus-positive and virus-negative group. A larger proportion of the virus-positive patients had been previously treated with oral corticosteroids than had the virus-negative patients (37.5% versus 14.3%) (P=0.039). The viral-positive groups presented with more sore throat symptoms than did the viral-negative groups (62.5% versus 33.9%) (P=0.04). The family cluster of common cold symptoms was significantly higher for viral-positive groups than viral-negative groups (25% versus 1.8%) (P=0.001).

Bottom Line: 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.Those with increased sputum during a COPD exacerbation had higher risks for recurrent exacerbations.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan.

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.

No MeSH data available.


Related in: MedlinePlus