A Study on the Serum Procalcitonin Level after Conventional Intravenous Antibiotic Treatment to Predict the Risk of Re-exacerbation in Infectious Acute Exacerbation of Chronic Obstructive Pulmonary Disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LiuYuanyuan , JiaLian , LiYalun ,  LiuChuntao

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China;

Corresponding author：

LiuChuntao, Email: taosen666@vip.163.com

Keywords：

Chronic obstructive pulmonary disease; Exacerbation; Procalcitonin; Neutrophils percentage; Antibiotics

DOI：

10.7507/1671-6205.2015107

Video：

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Objective To evaluate the value of serum procalcitonin (PCT) level after conventional intravenous antibiotic treatment to predict the risk of re-exacerbation, and vertify the feasiblity of an additional course of oral antibiotics after discharge to reduce the risk of re-exacerbation. Methods The patients who hospitalized in West China Hospital from October 2012 to October 2013 because of infectious acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were recruited. The concentrations of PCT and C-reactive protein (CRP), the number of white blood cell (WBC) and neutrophil percentage at the end of intravenous antibiotic therapy were recorded. The information about additional course of antibiotics was collected according to the medical instruction and visit. The subjects were followed up for 1 year.The time to the first re-exacerbation and frequencies of exacerbations were recorded. The Cox regression model was used to estimate the hazard rations (HR). Results One hundred and thirty-eight eligible patients were included totally. The HRs in PCT≥0.11μg/L and neutrophil percentage≥70% were 1.462 (P=0.035) and 1.673 (P=0.005) respectively, suggesting higher risk of re-exacerbation. There was no relationship of CRP (P=0.330) or WBC (P=0.432) with the risk of re-exacerbation. Generally an additional course of antibiotics had no effects on re-exacerbation (P=0.231) but this therapy could reduce the risk of re-exacerbation in high PCT level group (HR=2.29, P=0.004). Conclusions Serum PCT concentrations and neutrophil percentage after conventional intravenous antibiotic treatment can predict the risk of re-exacerbations in the future. An additional course of antibiotics in the patients with high PCT level can reduce the risk of re-exacerbation.

Citation： LiuYuanyuan, JiaLian, LiYalun, LiuChuntao. A Study on the Serum Procalcitonin Level after Conventional Intravenous Antibiotic Treatment to Predict the Risk of Re-exacerbation in Infectious Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(5): 430-435. doi: 10.7507/1671-6205.2015107 Copy

1.	Original Articles1郑晓文, 陈一强, 张剑锋, 等.不同炎症指标联合检测在AECOPD中的诊断与应用.广西医科大学学报, 2013, 30:376-378.
2.	常春, 姚婉贞, 陈亚红, 等.血清降钙素原对慢性阻塞性肺疾病加重期患者下呼吸道细菌感染的诊断价值.北京大学学报(医学版), 2006, 38:389-392.
3.	谢岚, 毛欣, 李建刚, 等.降钙素原在慢性阻塞性肺疾病急性加重期抗生素使用中的指导意义.中国呼吸与危重监护杂志, 2013, 12:237-239.
4.	曾雪峰, 陈锋, 刘楠, 等.降钙素原在指导慢性阻塞性肺疾病急性加重期抗感染治疗中的价值.实用医学杂志, 2010, 26:4093-4095.
5.	姜小建, 鱼军, 杜旭升, 等.血清降钙素原的检测对指导慢性阻塞性肺疾病急性加重期抗菌治疗价值的meta分析.国际检验医学杂志, 2013, 34:1955-1958.
6.	徐志, 黄忠毅.血清降钙素原在慢性阻塞性肺疾病急性加重期患者的表达水平及其临床意义.临床医学工程, 2014, 21:321-322.
7.	胡小佳, 周芳, 裘宇容, 等.血清降钙素原和C-反应蛋白在慢性支气管炎急性发作期患者中的临床评价.南方医科大学学报, 2010, 30:1618-1620.
8.	Briel M, Schuetz P, Mueller B, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med, 2008, 168:2000-2007.
9.	Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet, 1993, 341:515-518.
10.	Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blinded intervention trial. Lancet, 2004, 363:600-607.
11.	Wilson R, Jones P, Schaberg T, et al. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Thorax, 2006, 61:337-342.
12.	Lacoma A, Prat C, Andreo F, et al. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2011, 6:157-169.
13.	Albrich WC, Dusemund F, Bucher B, et al. Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in "real life":an international, multicenter poststudy survey (ProREAL). Arch Intern Med, 2012, 172:715-722.
14.	Niewoehner DE. Procalcitonin level-guided treatment reduced antibiotic use in exacerbations of COPD. ACP J Club, 2007, 146:57-59.
15.	Franciosi LG, Page CP, Celli BR, et al. Markers of exacerbation severity in chronic obstructive pulmonary disease. Respir Res, 2006, 7:74.
16.	Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections:the ProHOSP randomized controlled trial. JAMA, 2009, 302:1059-1066.
17.	Burge S, Wedzicha JA. COPD exacerbations:definitions and classifications. Eur Respir J, 2003, 21:46-53.
18.	Soler N. Systemic markers of exacerbated chronic obstructive pulmonary disease:how they can help with the decision of whether or not to prescribe antibiotics. Arch Bronconeumol, 2008, 44:581-583.
19.	Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2012, 12:CD010257.
20.	Schuetz P, Müller B, Christ-Crain M, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev, 2012, 9:CD007498.
21.	李俊, 陈弘群, 蒋世锋, 等.血清降钙素原和超敏C-反应蛋白在AECOPD的作用.临床肺科杂志, 2012, 17:1368-1370.
22.	Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COFD:a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest, 2007, 131:9-19.
23.	Briel M, Christ-Crain M, Young J, et al. Procalcitonin-guided antibiotic use versus a standard approach for acute respiratory tract infections in primary care:study protocol for a randomized controlled trial and baseline characteristics of participating general practitioners. BMC Fam Pract, 2005, 6:34.
24.	秦娥.慢性阻塞性肺疾病急性加重期患者血清降钙素原测定的临床意义.现代实用医学杂志, 2010, 22:676-677.
25.	Soler M, Esperatti M, Ewig S, et al. Sputum purulence-guided antibiotic use in hospitalised patients with exacerbations of COPD. Eur Respir J, 2012, 40:1344-1353.
26.	Zhao YF, Jiang YP, Zhou LF, et al. The value of assessment tests in patients with acute exacerbation of chronic obstructive pulmonary disease. Am J Med Sci, 2014, 347:393-399.
27.	Shaw JG, Vaughan A, Dent AG, et al. Biomarkers of progression of chronic obstructive pulmonary disease (COPD). J Thorac Dis, 2014, 6:1532-1547.
28.	Steel DM, Whitehead AS. The major acute phase reactants:C-reative protain, serum amyloid P component and serum amyloid A protein. Immunol Today, 1994, 15:81-88.
29.	Agassandian M, Shurin GV, Ma Y, et al. C-reactive protein and lung diseases. Int J Biochem Cell Biol, 2014, 53:77-88.
30.	Pereira JM, Teixeira-Pinto A, Baslio C, et al. Can we predict pneumococcal bacteremia in patients with severe community-acquired pneumonia? J Crit Care, 2013, 28:970-974.
31.	Zhang Y, Bunjhoo H, Xiong W, et al. Association between C-reactive protein concentration and chronic obstructive pulmonary disease:a systematicreview and meta-analysis. Int Med Res, 2012, 40:1629-1635.
32.	Criner GL, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD:American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest, 2015, 147:894-942.
33.	Miravitlles M, Anzueto A. Antibiotic prophylaxis in COPD:why, when, and for whom? Pulm Pharmacol Ther, 2015, 32:119-123.

1. Original Articles1郑晓文, 陈一强, 张剑锋, 等.不同炎症指标联合检测在AECOPD中的诊断与应用.广西医科大学学报, 2013, 30:376-378.
2. 常春, 姚婉贞, 陈亚红, 等.血清降钙素原对慢性阻塞性肺疾病加重期患者下呼吸道细菌感染的诊断价值.北京大学学报(医学版), 2006, 38:389-392.
3. 谢岚, 毛欣, 李建刚, 等.降钙素原在慢性阻塞性肺疾病急性加重期抗生素使用中的指导意义.中国呼吸与危重监护杂志, 2013, 12:237-239.
4. 曾雪峰, 陈锋, 刘楠, 等.降钙素原在指导慢性阻塞性肺疾病急性加重期抗感染治疗中的价值.实用医学杂志, 2010, 26:4093-4095.
5. 姜小建, 鱼军, 杜旭升, 等.血清降钙素原的检测对指导慢性阻塞性肺疾病急性加重期抗菌治疗价值的meta分析.国际检验医学杂志, 2013, 34:1955-1958.
6. 徐志, 黄忠毅.血清降钙素原在慢性阻塞性肺疾病急性加重期患者的表达水平及其临床意义.临床医学工程, 2014, 21:321-322.
7. 胡小佳, 周芳, 裘宇容, 等.血清降钙素原和C-反应蛋白在慢性支气管炎急性发作期患者中的临床评价.南方医科大学学报, 2010, 30:1618-1620.
8. Briel M, Schuetz P, Mueller B, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med, 2008, 168:2000-2007.
9. Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet, 1993, 341:515-518.
10. Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blinded intervention trial. Lancet, 2004, 363:600-607.
11. Wilson R, Jones P, Schaberg T, et al. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Thorax, 2006, 61:337-342.
12. Lacoma A, Prat C, Andreo F, et al. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2011, 6:157-169.
13. Albrich WC, Dusemund F, Bucher B, et al. Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in "real life":an international, multicenter poststudy survey (ProREAL). Arch Intern Med, 2012, 172:715-722.
14. Niewoehner DE. Procalcitonin level-guided treatment reduced antibiotic use in exacerbations of COPD. ACP J Club, 2007, 146:57-59.
15. Franciosi LG, Page CP, Celli BR, et al. Markers of exacerbation severity in chronic obstructive pulmonary disease. Respir Res, 2006, 7:74.
16. Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections:the ProHOSP randomized controlled trial. JAMA, 2009, 302:1059-1066.
17. Burge S, Wedzicha JA. COPD exacerbations:definitions and classifications. Eur Respir J, 2003, 21:46-53.
18. Soler N. Systemic markers of exacerbated chronic obstructive pulmonary disease:how they can help with the decision of whether or not to prescribe antibiotics. Arch Bronconeumol, 2008, 44:581-583.
19. Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2012, 12:CD010257.
20. Schuetz P, Müller B, Christ-Crain M, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev, 2012, 9:CD007498.
21. 李俊, 陈弘群, 蒋世锋, 等.血清降钙素原和超敏C-反应蛋白在AECOPD的作用.临床肺科杂志, 2012, 17:1368-1370.
22. Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COFD:a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest, 2007, 131:9-19.
23. Briel M, Christ-Crain M, Young J, et al. Procalcitonin-guided antibiotic use versus a standard approach for acute respiratory tract infections in primary care:study protocol for a randomized controlled trial and baseline characteristics of participating general practitioners. BMC Fam Pract, 2005, 6:34.
24. 秦娥.慢性阻塞性肺疾病急性加重期患者血清降钙素原测定的临床意义.现代实用医学杂志, 2010, 22:676-677.
25. Soler M, Esperatti M, Ewig S, et al. Sputum purulence-guided antibiotic use in hospitalised patients with exacerbations of COPD. Eur Respir J, 2012, 40:1344-1353.
26. Zhao YF, Jiang YP, Zhou LF, et al. The value of assessment tests in patients with acute exacerbation of chronic obstructive pulmonary disease. Am J Med Sci, 2014, 347:393-399.
27. Shaw JG, Vaughan A, Dent AG, et al. Biomarkers of progression of chronic obstructive pulmonary disease (COPD). J Thorac Dis, 2014, 6:1532-1547.
28. Steel DM, Whitehead AS. The major acute phase reactants:C-reative protain, serum amyloid P component and serum amyloid A protein. Immunol Today, 1994, 15:81-88.
29. Agassandian M, Shurin GV, Ma Y, et al. C-reactive protein and lung diseases. Int J Biochem Cell Biol, 2014, 53:77-88.
30. Pereira JM, Teixeira-Pinto A, Baslio C, et al. Can we predict pneumococcal bacteremia in patients with severe community-acquired pneumonia? J Crit Care, 2013, 28:970-974.
31. Zhang Y, Bunjhoo H, Xiong W, et al. Association between C-reactive protein concentration and chronic obstructive pulmonary disease:a systematicreview and meta-analysis. Int Med Res, 2012, 40:1629-1635.
32. Criner GL, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD:American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest, 2015, 147:894-942.
33. Miravitlles M, Anzueto A. Antibiotic prophylaxis in COPD:why, when, and for whom? Pulm Pharmacol Ther, 2015, 32:119-123.

Chinese Journal of Respiratory and Critical Care Medicine

A Study on the Serum Procalcitonin Level after Conventional Intravenous Antibiotic Treatment to Predict the Risk of Re-exacerbation in Infectious Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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