Serum procalcitonin in predicting bacterial exacerbation of COPD and need for ventilatory support

Abstract

Context: Acute exacerbation of COPD is very common disease and 20% of the COPD patients keep getting admitted with exacerbation. Serum procalcitonin (PCT) measurement is important to discriminate bacterial infection from other causes of AECOPD. Quick recognition along with prompt intervention may be the only action that prevents respiratory failure. Aims: To correlate serum PCT level with bacteriological profile and their need for ventilatory support in patients with AECOPD. Settings and Design: Hospital-based comparative type of cross-sectional study was conducted at the department of respiratory medicine in a tertiary care center of Rajasthan. Methods and Material: This comparative type of cross-sectional study was conducted between 45 AECOPD patients and 35 stable COPD patients. Serum PCT levels and sputum pyogenic culture were noted in all subjects. Statistical Analysis Used: Data collected were entered into excel spreadsheet and quantitative data were expressed as number and percentage. Results: There was a highly statistically significant difference of mean PCT value (P value < 0.003) between AECOPD patients (1.34 ± 2.53 ng/ml) and stable COPD patients (0.07 ± 0.05 ng/ml). Also, we found a statistically significant difference of mean PCT value (P value < 0.001) between AECOPD patients infected with Pseudomonas aeruginosa (3.64 ng/dl) and with other bacteria. A statistically significant difference (P value < 0.001) was present among AECOPD patients that needed invasive ventilation (5.41 ± 4.01 ng/ml), non-invasive ventilation (0.65 ± 0.81 ng/ml) and those did not need mechanical ventilation (0.27 ± 0.25 ng/ml) regarding the mean values of PCT. Conclusions: Our study found that higher PCT levels in severe AECOPD patients were associated more with bacterial infection and necessity of ventilatory support. Serum PCT can be used as good biomarker for intensive care unit admission.