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

from the PROCALCIVIR and BPCTrea study group¹  Bernard Flocard²  Jean-Jacques Parienti³  François Fournel³  Michel Ramakers⁴  Fabrice Daviaud⁵  Xavier Valette⁶  Cédric Daubin⁶  Damien Du Cheyron⁶  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;Department of Biostatistics and Clinical Research, CHU de Caen;Department of Intensive Care Medicine, General Hospital;Department of Medial Intensive Care, Cochin University Hospital;Department of Medical Intensive Care, CHU de Caen;Department of Medical Intensive Care, CHU de Grenoble Alpes;Intensive Care Unit, Centre Hospitalier Lyon Sud;Service de Medecine Intensive Reanimation, AP-HP, Sorbonne université, Hôpital Tenon, Groupe de Recherche Clinique CARMAS, collegium Gallilée;Service de Médecine Intensive Et Réanimation, General Intensive Care Unit, Hôpital Raymond Poincaré (APHP), Raymond Poincaré Hospital;Universite Caen Normandie, Medical School, EA 4650, Signalisation, Electrophysiologie et Imagerie des lésions d’Ischemie-reperfusion Myocardique;

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: DOAJ

【 摘 要 】

Abstract Background To 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. Results Regarding 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). Conclusion Despite 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】

Unknown