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

Authors
  • Daubin, Cédric1
  • Fournel, François1
  • Thiollière, Fabrice2
  • Daviaud, Fabrice3
  • Ramakers, Michel4
  • Polito, Andréa5, 6
  • Flocard, Bernard7
  • Valette, Xavier1
  • Du Cheyron, Damien1
  • Terzi, Nicolas8, 9
  • Fartoukh, Muriel10
  • Allouche, Stephane11
  • Parienti, Jean-Jacques1, 12
  • 1 CHU de Caen, Caen, 14000, France , Caen (France)
  • 2 Centre Hospitalier Lyon Sud, Pierre Bénite, Hospices Civils de Lyon, France , Hospices Civils de Lyon (France)
  • 3 Cochin University Hospital, Paris, France , Paris (France)
  • 4 General Hospital, Saint Lô, France , Saint Lô (France)
  • 5 Hôpital Raymond Poincaré (APHP), Raymond Poincaré Hospital, Garches, France , Garches (France)
  • 6 U1173 Université de Versailles SQY–Paris Saclay - INSERM, Garches, France , Garches (France)
  • 7 Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France , Lyon (France)
  • 8 CHU de Grenoble Alpes, Grenoble, 38000, France , Grenoble (France)
  • 9 INSERM, U1042, University of Grenoble-Alpes, HP2, Grenoble, 38000, France , Grenoble (France)
  • 10 Sorbonne université, Hôpital Tenon, Groupe de Recherche Clinique CARMAS, collegium Gallilée, Paris, France , Paris (France)
  • 11 Universite Caen Normandie, Medical School, EA 4650, Signalisation, Electrophysiologie et Imagerie des lésions d’Ischemie-reperfusion Myocardique, Caen, 14000, France , Caen (France)
  • 12 EA2656 Groupe de Recherche sur l’Adaptation Microbienne (GRAM 2.0), Université Caen Normandie, Caen, France , Caen (France)
Type
Published Article
Journal
Annals of Intensive Care
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Mar 06, 2021
Volume
11
Issue
1
Identifiers
DOI: 10.1186/s13613-021-00816-6
Source
Springer Nature
Keywords
License
Green

Abstract

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.

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