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.

Copeptin, C-Reactive Protein, and Procalcitonin as Prognostic Biomarkers in Acute Exacerbation of COPD

CHEST Journal ◽  
2007 ◽  
Vol 131 (4) ◽  
pp. 1058-1067 ◽  
Author(s):  
Daiana Stolz ◽  
Mirjam Christ-Crain ◽  
Nils G. Morgenthaler ◽  
Jörg Leuppi ◽  
David Miedinger ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Prognostic Biomarkers ◽  
C Reactive Protein ◽  
Acute Exacerbation Of Copd ◽  
Reactive Protein ◽  
Exacerbation Of Copd

#54: Sensitivity and Specificity of Procalcitonin vs C Reactive Protein in Identifying Pediatric Bacterial infections

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S16-S16
Author(s):  
Sara Kim ◽  
Avni Bhatt ◽  
Silvana Carr ◽  
Frances Saccoccio ◽  
Judy Lew
Keyword(s):  
Urinary Tract ◽  
Sensitivity And Specificity ◽  
Urinary Tract Infections ◽  
Bacterial Infections ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Culture Positivity ◽  
Serious Bacterial Infections ◽  
Tract Infections ◽  
Culture Positive

Abstract Background Procalcitonin (PCT) and c-reactive protein (CRP) have been utilized in children to assess risk for serious bacterial infections. However, there have been different cut-offs reported for PCT and CRP, which yield different sensitivity and specificity. This study aims to compare the sensitivity and specificity of PCT and CRP in detecting serious bacterial infections (SBIs), specifically urinary tract infections, bacteremia and meningitis. Methods In this retrospective, single center cohort study from January 2018 to June 2019, we analyzed children with a fever greater than 38C with both PCT and CRP value within 24 hours of admission. Each patient had a blood, urine and/or cerebrospinal fluid culture collected within 48 hours of admission. No antibiotics were administered from the admitting hospital prior to collection of the PCT or CRP. Our gold standard was a positive culture obtained from blood, cerebrospinal fluid, or urine. The statistical analysis included categorical variables as percentages and compared them using the Fisher exact test. The optimal cutoff values for PCT or CRP were based on ROC curve analysis and Youden Index. Sensitivity and specificity analysis were based on literature review cut offs and ROC curves cut offs. Results Among 202 children, we had 45 culture positive patients (11 urinary tract infections, 4 meningitis, and 32 bacteremia). The patients with culture positivity had higher PCT levels (7.9 ng/mL vs 2.5 ng/mL, P=0.0111), CRP levels (110.9 mg/L vs 49.6 mg/L, P<0.0001) and temperature (39.2C vs 39C, P<0.0052). The area under the curve (AUC) comparing culture positivity vs negativity for all culture types was 0.72 (p<0.0001) for PCT and 0.66 (p=0.001) for CRP. In Figure 1, the AUC for culture positive bacteremia was 0.68 (p=0.0011) for PCT and 0.70 (p=0.0003). The AUC for culture positive urinary tract infections (UTI) only was 0.86 (p=0.0001) for PCT and 0.70 (p=0.3607). For the cut-off value for PCT at 0.5 ng/mL, the sensitivity and specificity was 64% (95% confidence interval [CI] 0.5–0.77) and 70% (95% CI 0.62–0.77) respectively in identifying children with bacterial infection. For the cut-off value for CRP at 20 mg/L, the sensitivity and specificity was 67% (95% CI 0.52–0.79) and 52% (95% CI 0.44–0.59) respectively in identifying children with bacterial infection. Conclusion In this study, PCT and CRP are nearly equivalent classifiers for detecting SBIs as a group and bacteremia, but PCT is statistically better for urinary tract infections; however, the clinical utility is unknown.

scholarly journals C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

Infection ◽  
2021 ◽  
Author(s):  
Isabell Pink ◽  
David Raupach ◽  
Jan Fuge ◽  
Ralf-Peter Vonberg ◽  
Marius M. Hoeper ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Roc Analysis ◽  
Secondary Infection ◽  
C Reactive Protein ◽  
Laboratory Findings ◽  
Secondary Bacterial Infection ◽  
Reactive Protein ◽  
Tract Infections

Abstract Purpose Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has spread around the world. Differentiation between pure viral COVID-19 pneumonia and secondary infection can be challenging. In patients with elevated C-reactive protein (CRP) on admission physicians often decide to prescribe antibiotic therapy. However, overuse of anti-infective therapy in the pandemic should be avoided to prevent increasing antimicrobial resistance. Procalcitonin (PCT) and CRP have proven useful in other lower respiratory tract infections and might help to differentiate between pure viral or secondary infection. Methods We performed a retrospective study of patients admitted with COVID-19 between 6th March and 30th October 2020. Patient background, clinical course, laboratory findings with focus on PCT and CRP levels and microbiology results were evaluated. Patients with and without secondary bacterial infection in relation to PCT and CRP were compared. Using receiver operating characteristic (ROC) analysis, the best discriminating cut-off value of PCT and CRP with the corresponding sensitivity and specificity was calculated. Results Out of 99 inpatients (52 ICU, 47 Non-ICU) with COVID-19, 32 (32%) presented with secondary bacterial infection during hospitalization. Patients with secondary bacterial infection had higher PCT (0.4 versus 0.1 ng/mL; p = 0.016) and CRP (131 versus 73 mg/L; p = 0.001) levels at admission and during the hospital stay (2.9 versus 0.1 ng/mL; p < 0.001 resp. 293 versus 94 mg/L; p < 0.001). The majority of patients on general ward had no secondary bacterial infection (93%). More than half of patients admitted to the ICU developed secondary bacterial infection (56%). ROC analysis of highest PCT resp. CRP and secondary infection yielded AUCs of 0.88 (p < 0.001) resp. 0.86 (p < 0.001) for the entire cohort. With a PCT cut-off value at 0.55 ng/mL, the sensitivity was 91% with a specificity of 81%; a CRP cut-off value at 172 mg/L yielded a sensitivity of 81% with a specificity of 76%. Conclusion PCT and CRP measurement on admission and during the course of the disease in patients with COVID-19 may be helpful in identifying secondary bacterial infections and guiding the use of antibiotic therapy.

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.

scholarly journals The Relationship Between Bacterial Pattern with Degree of Airflow Limitation FEV1 in Acute Exacerbation of COPD at Adam Malik General Hospital and Pirngadi Hospital

2019 ◽  
Vol 39 (3) ◽  
pp. 204-209
Author(s):  
Rianti Tarigan ◽  
Amira P Tarigan ◽  
Dian Dwi Wahyuni ◽  
Putri C Eyanoer
Keyword(s):  
General Hospital ◽  
Acute Exacerbation ◽  
Sputum Culture ◽  
Susceptibility Test ◽  
Airflow Limitation ◽  
Streptococcus Pneumonia ◽  
Acute Exacerbation Of Copd ◽  
Exacerbation Of Copd ◽  
Tract Infections ◽  
The Relationship

Background: Respiratory tract infections are the leading cause of acute exacerbation of COPD (AECOPD). The aim of this study was to investigate the relationship between bacterial pattern and the degree of airflow limitation (FEV1) in patients with acute exacerbation of COPD at Adam Malik General Hospital and Pirngadi Hospital, also the sensitive antibiotics according to the susceptibility test. Methods: This was a cross sectional study of all patients admitted to Adam Malik and Pirngadi Hospital with AECOPD from September 2015 until September 2016. In all 45 subjects who fulfilled the inclusion criteria, the spirometry was examination undergone to evaluate the degree of severity of COPD according to GOLD 2017. In each sample sputum expectoration, the gram smear was made. Barttlet criteria was used to calculate the amount of epithelial cells and PMN. The sample was then grown on blood agar medium. Bacterial susceptibility test to antibiotics was conducted using VITEC 2 methods. Results: From 45 patients, 30 patients (66,7%) had positive sputum cultures. The most frequently isolated pathogen was Streptococcus pneumonia (26,7%). The most sensitive antibiotic was Amikacin (100%). There were no correlation between the in degree of airflow limitation FEV1 and bacterial sputum culture result. There were no significant differences between gram positive or negative bacteria with the degree of airflow limitation. Conclusion: The incidence of bacterial infection based on positive sputum culture in AECOPD was about 66,7% Streptococcus pneumonia was the most common pathogen and Amikacin was the most sensitive antibiotic. There were no significant correlation between the degree of airflow limitation FEV1 with the positive or negative sputum culture and also with the result of gram staining. (J Respir Indo. 2019; 39(3):204-9)

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