Ability of procalcitonin to distinguish between bacterial and nonbacterial infection in severe acute exacerbation of chronic obstructive pulmonary syndrome in the ICU

Annals of Intensive Care

Bernard Flocard¹  François Fournel²  Jean-Jacques Parienti³  Michel Ramakers⁴  Fabrice Daviaud⁵  Cédric Daubin⁶  Damien Du Cheyron⁶  Xavier Valette⁶  Nicolas Terzi⁷  Fabrice Thiollière⁸  Muriel Fartoukh⁹  Andréa Polito^1,10  Stephane Allouche^1,11 

[1] Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France;Department of Biostatistics and Clinical Research, CHU de Caen, 14000, Caen, France;Department of Biostatistics and Clinical Research, CHU de Caen, 14000, Caen, France;EA2656 Groupe de Recherche sur l’Adaptation Microbienne (GRAM 2.0), Université Caen Normandie, Caen, France;Department of Intensive Care Medicine, General Hospital, Saint Lô, France;Department of Medial Intensive Care, Cochin University Hospital, Paris, France;Department of Medical Intensive Care, CHU de Caen, 14000, Caen, France;Department of Medical Intensive Care, CHU de Grenoble Alpes, 38000, Grenoble, France;INSERM, U1042, University of Grenoble-Alpes, HP2, 38000, Grenoble, France;Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, Hospices Civils de Lyon, France;Service de Medecine Intensive Reanimation, AP-HP, Sorbonne université, Hôpital Tenon, Groupe de Recherche Clinique CARMAS, collegium Gallilée, Paris, France;Service de Médecine Intensive Et Réanimation, General Intensive Care Unit, Hôpital Raymond Poincaré (APHP), Raymond Poincaré Hospital, Garches, France;Laboratoire Infection & Inflammation, U1173 Université de Versailles SQY–Paris Saclay - INSERM, Garches, France;Universite Caen Normandie, Medical School, EA 4650, Signalisation, Electrophysiologie et Imagerie des lésions d’Ischemie-reperfusion Myocardique, 14000, Caen, France;

关键词: Chronic obstructive pulmonary disease;    Procalcitonin;    Antibiotic stewardship;    Respiratory tract infection;    Community-acquired pneumonia;    Viral infection;   

DOI  :  10.1186/s13613-021-00816-6

来源: Springer

【 摘 要 】

BackgroundTo assess the ability of procalcitonin (PCT) to distinguish between bacterial and nonbacterial causes of patients with severe acute exacerbation of COPD (AECOPD) admitted to the ICU, we conducted a retrospective analysis of two prospective studies including 375 patients with severe AECOPD with suspected lower respiratory tract infections. PCT levels were sequentially assessed at the time of inclusion, 6 h after and at day 1, using a sensitive immunoassay. The patients were classified according to the presence of a documented bacterial infection (including bacterial and viral coinfection) (BAC + group), or the absence of a documented bacterial infection (i.e., a documented viral infection alone or absence of a documented pathogen) (BAC- group). The accuracy of PCT levels in predicting bacterial infection (BAC + group) vs no bacterial infection (BAC- group) at different time points was evaluated by receiver operating characteristic (ROC) analysis.ResultsRegarding the entire cohort (n = 375), at any time, the PCT levels significantly differed between groups (Kruskal–Wallis test, p < 0.001). A pairwise comparison showed that PCT levels were significantly higher in patients with bacterial infection (n = 94) than in patients without documented pathogens (n = 218) (p < 0.001). No significant difference was observed between patients with bacterial and viral infection (n = 63). For example, the median PCT-H0 levels were 0.64 ng/ml [0.22–0.87] in the bacterial group vs 0.24 ng/ml [0.15–0.37] in the viral group and 0.16 ng/mL [0.11–0.22] in the group without documented pathogens. With a c-index of 0.64 (95% CI; 0.58–0.71) at H0, 0.64 [95% CI 0.57–0.70] at H6 and 0.63 (95% CI; 0.56–0.69) at H24, PCT had a low accuracy for predicting bacterial infection (BAC + group).ConclusionDespite higher PCT levels in severe AECOPD caused by bacterial infection, PCT had a poor accuracy to distinguish between bacterial and nonbacterial infection. Procalcitonin might not be sufficient as a standalone marker for initiating antibiotic treatment in this setting.

【 授权许可】

CC BY