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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cédric Daubin ◽  
◽  
François Fournel ◽  
Fabrice Thiollière ◽  
Fabrice Daviaud ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Viral Infection ◽  
Acute Exacerbation ◽  
Pairwise Comparison ◽  
Chronic Obstructive ◽  
Entire Cohort ◽  
Severe Acute Exacerbation ◽  
Significant Difference ◽  
Exacerbation Of Copd ◽  
Tract Infections

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.

A COMPARATIVE STUDY TO EVALUATE C-REACTIVE PROTEIN AND PROCALCITONIN AS A MARKER OF BACTERIAL INFECTION IN PATIENTS WITH ACUTE EXACERBATION OF COPD.

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Nipun Agrawal ◽  
Anshul Jain ◽  
Lalit Singh ◽  
Abhishek Jain
Keyword(s):  
Bacterial Infection ◽  
Acute Exacerbation ◽  
Sensitivity And Specificity ◽  
Area Under Curve ◽  
Comorbid Condition ◽  
C Reactive Protein ◽  
Acute Exacerbation Of Copd ◽  
Reactive Protein ◽  
Exacerbation Of Copd ◽  
Tract Infections

INTRODUCTION: Exacerbations of COPD can be precipitated by several factors. The most common causes appear to be respiratory tract infections. Overuse of antibiotics is common and accelerates the development of drug resistance and hospital acquired infections. In some recent studies, both C-reactive protein as well as Procalcitonin levels have been shown to be useful in differentiating bacterial etiology of exacerbations and thus helping in guiding the treatment as well as in prediction of outcome. Evaluate sensitivity and specificity of C-reactive protein and Procalcitonin as a marker of bacterial infection in patients with acute exacerbation of COPD. MATERIAL AND METHODS: The present hospital-based observational study was carried out at Department of Pulmonary Medicine, SRMSIMS, Bareilly. 50 patients from patients of COPD with acute exacerbation attending/admitted to Pulmonary OPD/IPD were included in the study excluding those below 40yrs old or presenting with acute breathlessness due to comorbid condition. Demographic information, relevant clinical data and lab investigations were recorded from all patients including C-reactive protein and Procalcitonin on admission following which the patients were started antibiotics as per guidelines. Reassessment of S. Procalcitonin and C-reactive protein was done on 3rd and 7th day of hospitalization. ROC Curve was applied to compare sensitivity and specificity. RESULTS: Sputum culture was found positive in 27 (54.0%) patients. At all the three intervals, CRP levels had ROC area under curve (ROCAUC) values above 0.70. Area under curve value was maximum at day 3. For Procalcitonin, the area under curve values were >0.8 at day 1 and day 3 but on day 7 this value was only 0.624. On evaluating the correlation between S. C-Reactive Protein and Procalcitonin levels, a mild positive and significant correlation was observed at day 1 and day 7 intervals whereas on day 3 a moderate positive and significant correlation was observed between the two markers.CONCLUSION: CRP is good marker when tested early and late while PCT is better when tested early.

scholarly journals Epidemiological characteristics of four common respiratory viral infections in children

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Guohong Zhu ◽  
Dan Xu ◽  
Yuanyuan Zhang ◽  
Tianlin Wang ◽  
Lingyan Zhang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Viral Infection ◽  
Influenza A ◽  
Multiple Infection ◽  
Influenza B ◽  
Preschool Period ◽  
Significant Difference ◽  
Different Seasons ◽  
Tract Infections ◽  
Epidemiological Characteristics

Abstract Background Viruses are the main infectious agents of acute respiratory infections in children. We aim to describe the epidemiological characteristics of viral pathogens of acute respiratory tract infections in outpatient children. Methods From April 2018 to March 2019, the results of viral detection using oral pharyngeal swabs from 103,210 children with acute respiratory tract infection in the outpatient department of the Children’s Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. Viral antigens, including adenovirus (ADV), influenza A (FLUA), influenza B (FLUB) and respiratory syncytial virus (RSV), were detected by the colloidal gold method. Results At least one virus was detected in 38,355 cases; the positivity rate was 37.2%. A total of 1910 cases of mixed infection with two or more viruses were detected, and the positivity rate of multiple infection was 1.9%. The ADV positivity rate was highest in the 3–6-year-old group (18.7%), the FLUA positivity rate was highest in the > 6-year-old group (21.6%), the FLUB positivity rate was highest in the > 6-year-old group (6.6%), and the RSV positivity rate was highest in the < 1-year-old group (10.6%). There was a significant difference in the positivity rate of viral infection among different age groups (χ2 = 1280.7, P < 0.001). The rate of positive viral infection was highest in winter (47.1%). The ADV infection rate was highest in spring (18.2%). The rates of FLUA and FLUB positivity were highest in winter (28.8% and 3.6%, respectively). The rate of RSV positivity was highest in autumn (17.4%). The rate of positive viral infection in different seasons was significantly different (χ2 = 6459.1, P < 0.001). Conclusions Viral infection rates in children differ for different ages and seasons. The positivity rate of ADV is highest in the preschool period and that of RSV is highest in infants; that of FLU increases with age. The total positive rate of viral infection in different seasons is highest in winter, as is the rate of FLU positivity.

scholarly journals Effects of Mangosteen pericarp Extract to Clinical Improvements, The Plasma Level of IL-6 and Malondialdehyde in Acute Exacerbation of COPD Patients

2018 ◽  
Vol 38 (3) ◽  
pp. 164-172
Author(s):  
Khilyatul Baroroh ◽  
Suradi Suradi ◽  
Ade Rima
Keyword(s):  
Treatment Group ◽  
Plasma Level ◽  
Length Of Stay ◽  
Acute Exacerbation ◽  
Clinical Symptoms ◽  
Control Group ◽  
Chronic Obstructive ◽  
Copd Patients ◽  
Significant Difference ◽  
And Control

Background: Amplification of inflammation in acute exacerbation of chronic obstructive pulmonary disease (COPD) increases inflammatory mediators and oxidative stress in the airways, pulmonary and systemic circulation that are characterized by increased plasma level of IL-6 and MDA, resulting in worsening of clinical symptoms. Xanthones in mangosteen pericarp have anti-inflammatory and antioxidant effects, potentially as an adjuntive therapy in acute exacerbations of COPD. Methods: The aim of this study was to determine the effect of mangosteen pericarp extract to clinical improvements, plasma level of IL-6 and MDA of acute exacerbation COPD patients. A clinical trial of experimental with pretest and posttest was conducted on 34 acute exacerbation of COPD patients in Dr. Moewardi Hospital Surakarta and Dr. Ario Wirawan Lung Hospital Salatiga from April until May 2016. The sample was taken by consecutive sampling. Subjects were divided by randomized double blind technique into the treatment group (n=17) received mangosteen pericarp extract 2x1100mg/day and control group (n = 17) received placebo. Clinical improvements were measured in CAT score and length of stay. CAT score, plasma level of IL-6 and MDA were measured on admission and at discharge. Length of stay based on the number of days of care in hospitals. Results: There was significant difference (p=0,011) towards decreased of IL-6 plasma level between treatment group (-2,17 ± 3,46 pg/ mL) and control group (+1,67 ± 6,81 pg/mL). There were no significant difference towards decreased of length of stay (p=0,34) between treatment group (4,12 ± 1,54 days) and control group (5,24 ± 2,49 days), towards decreased of CAT score (p=0,252) between treatment group (-19,18 ± 3,96) and control group (-18,24 ± 2,75), and towards decreased of MDA plasma level (p=0,986) between treatment group (+0,03 ± 0,36μmol/L) and control group (+0,35 ± 1,58). Conclusions: The addition of mangosteen pericarp extract 2x1100mg/day during hospitalization was significantly lowered plasma levels of IL-6, but were not significant in lowering the CAT score, shortening the length of stay, and reducing the increase in plasma level of MDA.

scholarly journals Study of Serum B-Type Natriuretic Peptide (BNP) Levels as a Prognostic Marker in Acute Exacerbation of COPD in HSK Hospital, Bagalkot, Karnataka

2021 ◽  
Vol 8 (19) ◽  
pp. 1332-1335
Author(s):  
Sunil Baragi ◽  
Kadappa Jaligidad ◽  
Joachim Piedade Souza
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Hypertension ◽  
Partial Pressure ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Duration Of Hospital Stay ◽  
Life Threatening ◽  
Exacerbation Of Copd

BACKGROUND Pulmonary hypertension (PH) and heart failure are common comorbidities in 20 – 30 % of chronic obstructive pulmonary disease (COPD) patients with acute exacerbation. Similarities in signs and symptoms and lack of objective measures to stratify them at emergency department makes the management difficult. Echocardiography though useful requires specialised training. Hence, B-Type Natriuretic Peptide (BNP) is a simple test that can prognosticate the severity and can influence management in such patients. The purpose of the study was to estimate the significance of BNP during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) as an important marker of severity and to study its correlation with duration of hospital stay, place and mode of management in patients with severe and life-threatening exacerbation of COPD. METHODS This is a prospective longitudinal observational study conducted on 50 patients of severe and life-threatening COPD exacerbation admitted to General Medicine department of HSK hospital, Bagalkot and their outcomes were noted based on the BNP levels. RESULTS The study showed higher levels of BNP in patients admitted to ICU as compared to emergency ward (P = 0.001). Greater values among those on invasive mechanical ventilation vs. non-invasive ventilation (NIV). There was a positive correlation and statistical significance of BNP values with arterial blood gases (ABG) parameters like pulmonary hypertension (PH), partial pressure of carbondi-oxide (PaCO2), partial pressure of oxygen (PaO2), echo parameters like right ventricle (RV) diameter and pulmonary artery systolic pressure (PASP) and duration of hospital stay. CONCLUSIONS BNP is a simple, low cost and easily available blood test that can prognosticate oxygen requirement, mode of ventilation, place of management and can grade and reflect the severity in acute exacerbation of COPD. KEYWORDS AECOPD, BNP, Prognostic Marker, Outcome

scholarly journals Usefulness of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections in children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yang Li ◽  
Lanfang Min ◽  
Xin Zhang
Keyword(s):  
Differential Diagnosis ◽  
Respiratory Tract ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Diagnostic Value ◽  
Significant Difference ◽  
Group A ◽  
Tract Infections

Abstract Background There is a lack of studies comparing PCT, CRP and WBC levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections. It is necessary to explore the correlation between above markers and different types of ARTI. Methods 108 children with confirmed bacterial infection were regarded as group A, 116 children with virus infection were regarded as group B, and 122 children with mycoplasmal infection were regarded as group C. The levels of PCT, CRP and WBC of the three groups were detected and compared. Results The levels of PCT, CRP and WBC in group A were significantly higher than those in groups B and C (p < 0.05). The positive rate of combined detection of PCT, CRP and WBC was significant higher than that of single detection. There was no significant difference in PCT, CRP and WBC levels between the group of G+ bacterial infection and G− bacterial infection (p > 0.05). ROC curve results showed that the AUC of PCT, CRP and WBC for the diagnosis of bacterial respiratory infections were 0.65, 0.55, and 0.58, respectively. Conclusions PCT, CRP and WBC can be combined as effective indicators for the identification of acute bacterial or no-bacterial infections in children. The levels of PCT and CRP have higher differential diagnostic value than that of WBC in infection, and the combined examination of the three is more valuable in clinic.

scholarly journals Correlation between arterial and venous blood gas analysis parameters in patients with acute exacerbation of chronic obstructive pulmonary disease

2012 ◽  
Vol 140 (7-8) ◽  
pp. 436-440 ◽  
Author(s):  
Milos Novovic ◽  
Vesna Topic
Keyword(s):  
Acute Exacerbation ◽  
Venous Blood ◽  
Chronic Obstructive ◽  
Blood Gas ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Arterial Blood ◽  
Exacerbation Of Copd ◽  
Venous Blood Gas ◽  
Oxygen Status

Introduction. Arterial blood gas (ABG) analyses have an important role in the assessment and monitoring of the metabolic and oxygen status of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Arterial puncture could have a lot of adverse effects, while sampling of venous blood is simpler and is not so invasive. Objective. The aim of this study was to evaluate whether venous blood gas (VBG) values of pH, partial pressure of carbon dioxide (PCO2), partial oxygen pressure (PO2), bicarbonate (HCO3), and venous and arterial blood oxygen saturation (SO2) can reliably predict ABG levels in patients with acute exacerbation of COPD. Methods. Forty-seven patients with a prior diagnosis of COPD were included in this prospective study. The patients with acute exacerbation of this disease were examined at the General Hospital EMS Department in Prijepolje. ABG samples were taken immediately after venous sampling, and both were analyzed. Results. The Pearson correlation coefficients between arterial and venous parameters were 0.828, 0.877, 0.599, 0.896 and 0.312 for pH, PCO2, PO2, HCO3 and SO2, respectively. The statistically significant correlation between arterial and venous pH, PCO2 and HCO3, values was found in patients with acute exacerbation of COPD (p<0.001). Conclusion. When we cannot provide arterial blood for analysis, venous values of the pH, Pv,CO2 and HCO3 parameters can be an alternative to their arterial equivalents in the interpretation of the metabolic status in patients with acute exacerbation of COPD, while the values of venous Pv,O2 and Sv,O2 cannot be used as predictors in the assessment of oxygen status of such patients.

scholarly journals Systemic inflammation induced by exacerbation of COPD or pneumonia in patients with COPD induces cardiac troponin elevation

2021 ◽  
Vol 8 (1) ◽  
pp. e000997
Author(s):  
Vidar Søyseth ◽  
Natalia Kononova ◽  
Anke Neukamm ◽  
Nils Henrik Holmedahl ◽  
Tor-Arne Hagve ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Systemic Inflammation ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Geometric Mean ◽  
Stable State ◽  
High Sensitivity ◽  
Chronic Obstructive ◽  
Troponin Elevation ◽  
Exacerbation Of Copd

BackgroundTroponin is a biomarker of myocardial injury. In chronic obstructive pulmonary disease (COPD), troponin is an important determinant of mortality after acute exacerbation. Whether acute exacerbation of COPD (AECOPD) causes troponin elevation is not known. Here, we investigated whether troponin is increased in AECOPD compared to stable COPD.MethodsWe included 320 patients with COPD in the stable state and 63 random individuals from Akershus University hospital’s catchment area. All participants were ≥40 years old (mean 65·1 years, SD 7·6) and 176 (46%) were females. The geometric mean of high-sensitivity cardiac troponin T (hs-cTnT) was 6·9 ng/L (geometric-SD 2·6). They were followed regarding hospital admission for the subsequent 5 years.ResultsDuring the 5-year follow-up, we noted 474 hospitalisations: Totally, 150 and 80 admissions were due to AECOPD or pneumonia, respectively. The geometric mean ratio with geometric SE (GSE) between cTnT at admission and stable state in AECOPD and pneumonia was 1·27 (GSE=1.11, p=0·023) and 1·28 (GSE=1.14, p=0·054), respectively. After inclusion of blood leucocyte count and C reactive protein at hospitalisation, these ratios attenuated to zero. However, we estimated an indirect of AECOPD and pneumonia on the ratio between hs-cTnT at admission and the stable state to 1·16 (p=0·022) and 1·22 (p=0·008), representing 91% (95% CI 82% to 100%) and 95% (95% CI 83% to 100%) of the total effects, respectively.ConclusionAECOPD and pneumonia in patients with COPD is associated with higher cTnT levels. This association appears to be mediated by systemic inflammation.

Physical activity during and after a severe acute exacerbation of COPD

2021 ◽  
Author(s):  
Kirsten Quadflieg ◽  
Ana Machado ◽  
Fabiano De Lima ◽  
Marc Daenen ◽  
David Ruttens ◽  
...  
Keyword(s):  
Physical Activity ◽  
Acute Exacerbation ◽  
Acute Exacerbation Of Copd ◽  
Severe Acute Exacerbation ◽  
Exacerbation Of Copd

Microalbuminuria on admission for acute exacerbation of COPD as a predictor of all-cause mortality and future exacerbations

2021 ◽  
pp. postgradmedj-2021-141206
Author(s):  
Konstantinos Bartziokas ◽  
Christos Kyriakopoulos ◽  
Evangelia Dounousi ◽  
Konstantinos Kostikas
Keyword(s):  
Acute Exacerbation ◽  
Chronic Obstructive Lung Disease ◽  
Multivariate Regression Analysis ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbation Of Copd ◽  
Tertiary Hospitals ◽  
Exacerbation Of Copd

ObjectivesMicroalbuminuria (MAB) is a sensitive biomarker of cardiovascular risk that is directly associated with cardiovascular events and mortality. Recent studies have evaluated the presence of MAB in patients with stable chronic obstructive pulmonary disease (COPD) or hospitalised for acute exacerbation of COPD (AECOPD).MethodsWe evaluated 320 patients admitted for AECOPD in respiratory medicine departments of two tertiary hospitals. On admission, demographic, clinical and laboratory values and COPD severity were assessed. Patients were evaluated monthly for 1 year, recording new AECOPD and death from any cause.ResultsPatients with documented MAB (urinary albumin excretion of 30–300 mg/24 hours) on admission had worse lung function (forced expiratory volume in 1 s, %) (mean (SD) 34.2 (13.6)% vs 61.5 (16.7)%), higher modified Medical Research Council (3.6 (1.2) vs 2.1 (0.8)), lower 6 min walk test (171 (63) vs 366 (104)) and more hospitalisation days (9 (2.8) vs 4.7 (1.9)) (p<0.001 for all comparisons). MAB was also correlated with Global Initiative for Chronic Obstructive Lung Disease 2020 COPD stages (p<0.001). In multivariate regression analysis, MAB was a significant predictor of longer hospitalisation duration (OR 6.847, 95% CI 3.050 to 15.370, p<0.0001). Twelve-month follow-up revealed that patients with MAB experienced more AECOPDs (4.6 (3.6) vs 2.2 (3.5), p<0.0001) and deaths, n (%) (52 (36.6) vs 14 (7.8), p<0.001). Kaplan-Meier survival curves demonstrated that patients with MAB presented with increased mortality, AECOPD and hospitalisation for AECOPD risk at 1 year (p<0.001 for all comparisons).ConclusionsThe presence of MAB on admission for AECOPD was associated with more severe COPD and prolonged hospitalisation, as well as with higher rates of AECOPD and mortality risk at 1-year follow-up.

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