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. 2009 Sep 21:9:157.
doi: 10.1186/1471-2334-9-157.

Procalcitonin levels and bacterial aetiology among COPD patients admitted to the ICU with severe pneumonia: a prospective cohort study

Cédric Daubin  1 , Jean-Jacques Parienti, Sabine Fradin, Astrid Vabret, Michel Ramakers, Nicolas Terzi, François Freymuth, Pierre Charbonneau, Damien du Cheyron
Affiliations

Procalcitonin levels and bacterial aetiology among COPD patients admitted to the ICU with severe pneumonia: a prospective cohort study

Cédric Daubin et al. BMC Infect Dis. .

Abstract

Background: Serum procalcitonin (PCT) is considered useful in predicting the likeliness of developing bacterial infections in emergency setting. In this study, we describe PCT levels overtime and their relationship with bacterial infection in chronic obstructive pulmonary disease (COPD) critically ill patients with pneumonia.

Methods: We conducted a prospective cohort study in an ICU of a University Hospital. All consecutive COPD patients admitted for pneumonia between September 2005 and September 2006 were included. Respiratory samples were tested for the presence of bacteria and viruses. Procalcitonin was sequentially assessed and patients classified according to the probability of the presence of a bacterial infection.

Results: Thirty four patients were included. The PCT levels were assessed in 32/34 patients, median values were: 0.493 microg/L [IQR, 0.131 to 1.471] at the time of admission, 0.724 microg/L [IQR, 0.167 to 2.646] at six hours, and 0.557 microg/L [IQR, 0.123 to 3.4] at 24 hours. The highest PCT (PCTmax) levels were less than 0.1 microg/L in 3/32 (9%) patients and greater than 0.25 microg/L in 22/32 (69%) patients, suggesting low and high probability of bacterial infection, respectively. Fifteen bacteria and five viruses were detected in 15/34 (44%) patients. Bacteria were not detected in patients with PCTmax levels < 0.1 microg/L. In contrast, bacteria were detected in 4/7 (57%) patients estimated unlikely to have a bacterial infection by PCT levels (PCTmax > 0.1 and < 0.25 microg/L).

Conclusion: Based on these results we suggest that a PCT level cut off > 0.1 microg/L may be more appropriate than 0.25 microg/L (previously proposed for non severe lower respiratory tract infection) to predict the probability of a bacterial infection in severe COPD patients with pneumonia. Further studies testing procalcitonin-based antibiotic strategies are needed in COPD patients with severe pneumonia.

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Figures

Figure 1
Figure 1
Distribution of the highest procalcitonin level measurements (PCTmax) and microorganism findings in chronic obstructive pulmonary disease (COPD) patients with pneumonia. Also shown is the probability of bacterial infection according to procalcitonin (PCT) levels, as previously reported by Christ-Crain (11). * Procalcitonin (PCT) levels were not assessed in 2 patients. ** One patient receiving antibiotic in 24 h prior ICU was not assessed for PCT levels.
Figure 2
Figure 2
Dynamics of PCT measurements and bacterial findings. * Procalcitonin (PCT) levels were not assessed in 2 patients. ** A bacterial co-infection was detected in 2 patients.
See this image and copyright information in PMC

References

    1. Lieberman D, Lieberman D, Gelfer Y, Varshavsky R, Dvoskin B, Leinonen M, Friedman MG. Pneumonic vs nonpneumonic acute exacerbations of COPD. Chest. 2002;122:1264–70. doi: 10.1378/chest.122.4.1264. - DOI - PMC - PubMed
    1. Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, Heijden G van der, Verheij TJ. European Respiratory Society. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J. 2005;26:1138–1180. doi: 10.1183/09031936.05.00055705. - DOI - PubMed
    1. Société de Pathologie Infectieuse de Langue Française. [15th consensus conference about management of lower respiratory tract infections in immunocompetent adult] Med Mal Infect. 2006;36:235–244. - PubMed
    1. Torres A, Dorca J, Zalacaín R, Bello S, El-Ebiary M, Molinos L, Arévalo M, Blanquer J, Celis R, Iriberri M, Prats E, Fernández R, Irigaray R, Serra J. Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. Am J Respir Crit Care Med. 1996;154:1456–61. - PubMed
    1. Cameron RJ, de Wit D, Welsh TN, Ferguson J, Grissell TV, Rye PJ. Virus infection in exacerbations of chronic obstructive pulmonary disease requiring ventilation. Intensive Care Med. 2006;32:1022–1029. doi: 10.1007/s00134-006-0202-x. - DOI - PMC - PubMed

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