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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

Kaplan–Meier survival curves (A) for the patients with high CRP levels and low CRP levels, and (B) for the patients with high PCT levels and low PCT levels.Abbreviations: CRP, C-reactive protein; ED, emergency department; PCT, procalcitonin.
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f4-copd-10-767: Kaplan–Meier survival curves (A) for the patients with high CRP levels and low CRP levels, and (B) for the patients with high PCT levels and low PCT levels.Abbreviations: CRP, C-reactive protein; ED, emergency department; PCT, procalcitonin.

Mentions: The percentage of patients free from readmission to the EDs in 1 year, analyzed by Kaplan–Meier curves and evaluated with the log-rank test, was not significantly different between the bacteria-positive and bacteria-negative groups. The curves for patients who were virus-positive and virus-negative also did not differ significantly (Figure 3). When the outcomes were analyzed specifically by PCT and CRP levels, the percentage of patients free from readmission to the EDs also showed no statistically significant differences (Figure 4).


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)

Kaplan–Meier survival curves (A) for the patients with high CRP levels and low CRP levels, and (B) for the patients with high PCT levels and low PCT levels.Abbreviations: CRP, C-reactive protein; ED, emergency department; PCT, procalcitonin.
© Copyright Policy
Related In: Results  -  Collection

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

f4-copd-10-767: Kaplan–Meier survival curves (A) for the patients with high CRP levels and low CRP levels, and (B) for the patients with high PCT levels and low PCT levels.Abbreviations: CRP, C-reactive protein; ED, emergency department; PCT, procalcitonin.
Mentions: The percentage of patients free from readmission to the EDs in 1 year, analyzed by Kaplan–Meier curves and evaluated with the log-rank test, was not significantly different between the bacteria-positive and bacteria-negative groups. The curves for patients who were virus-positive and virus-negative also did not differ significantly (Figure 3). When the outcomes were analyzed specifically by PCT and CRP levels, the percentage of patients free from readmission to the EDs also showed no statistically significant differences (Figure 4).

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