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Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits.

Abstract

BACKGROUND

Viral and bacterial infections are the most common causes of chronic obstructive pulmonary disease (COPD) exacerbations. Whether serum inflammatory markers can differentiate bacterial from virus infection in patients with COPD exacerbation requiring emergency department (ED) visits remains controversial.

METHODS

Viral culture and polymerase chain reaction (PCR) were used to identify the viruses in the oropharynx of patients with COPD exacerbations. The bacteria were identified by the semiquantitative culture of the expectorated sputum. The peripheral blood white blood cell (WBC) counts, serum C-reactive protein (CRP), procalcitonin (PCT), and clinical symptoms were compared among patients with different types of infections.

RESULTS

Viruses were isolated from 16 (22.2%) of the 72 patients enrolled. The most commonly identified viruses were parainfluenza type 3, influenza A, and rhinovirus. A total of 30 (41.7%) patients had positive bacterial cultures, with the most commonly found bacteria being Haemophilus influenzae and Haemophilus parainfluenzae. Five patients (6.9%) had both positive sputum cultures and virus identification. The WBC, CRP, and PCT levels of the bacteria-positive and bacteria-negative groups were not statistically different. Multivariate analysis showed that patients with increased sputum volumes during the COPD exacerbations had higher risks of recurrent exacerbations in the 1-year period following the first exacerbation.

CONCLUSION

WBC, CRP, or PCT could not differentiate between bacterial and viral infections in patients with COPD exacerbation requiring ED visits. Those with increased sputum during a COPD exacerbation had higher risks for recurrent exacerbations.

Authors+Show Affiliations

Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan.Department of Laboratory Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Taoyuan, Taiwan ; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan.Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan.Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan.Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan.Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan.Department of Pulmonary and Critical Care Medicine, Linkou Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chang-Gung University College of Medicine, Taoyuan, Taiwan ; Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan.Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan ; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Puzi City, Taiwan.Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan ; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Puzi City, Taiwan.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25926728

Citation

Chang, Chih-Hao, et al. "Procalcitonin and C-reactive Protein Cannot Differentiate Bacterial or Viral Infection in COPD Exacerbation Requiring Emergency Department Visits." International Journal of Chronic Obstructive Pulmonary Disease, vol. 10, 2015, pp. 767-74.
Chang CH, Tsao KC, Hu HC, et al. Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits. Int J Chron Obstruct Pulmon Dis. 2015;10:767-74.
Chang, C. H., Tsao, K. C., Hu, H. C., Huang, C. C., Kao, K. C., Chen, N. H., Yang, C. T., Tsai, Y. H., & Hsieh, M. J. (2015). Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits. International Journal of Chronic Obstructive Pulmonary Disease, 10, 767-74. https://doi.org/10.2147/COPD.S76740
Chang CH, et al. Procalcitonin and C-reactive Protein Cannot Differentiate Bacterial or Viral Infection in COPD Exacerbation Requiring Emergency Department Visits. Int J Chron Obstruct Pulmon Dis. 2015;10:767-74. PubMed PMID: 25926728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits. AU - Chang,Chih-Hao, AU - Tsao,Kuo-Chien, AU - Hu,Han-Chung, AU - Huang,Chung-Chi, AU - Kao,Kuo-Chin, AU - Chen,Ning-Hung, AU - Yang,Cheng-Ta, AU - Tsai,Ying-Huang, AU - Hsieh,Meng-Jer, Y1 - 2015/04/13/ PY - 2015/5/1/entrez PY - 2015/5/1/pubmed PY - 2016/2/5/medline KW - CRP KW - bacterial infection KW - chronic obstructive pulmonary disease KW - virus SP - 767 EP - 74 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 10 N2 - BACKGROUND: Viral and bacterial infections are the most common causes of chronic obstructive pulmonary disease (COPD) exacerbations. Whether serum inflammatory markers can differentiate bacterial from virus infection in patients with COPD exacerbation requiring emergency department (ED) visits remains controversial. METHODS: Viral culture and polymerase chain reaction (PCR) were used to identify the viruses in the oropharynx of patients with COPD exacerbations. The bacteria were identified by the semiquantitative culture of the expectorated sputum. The peripheral blood white blood cell (WBC) counts, serum C-reactive protein (CRP), procalcitonin (PCT), and clinical symptoms were compared among patients with different types of infections. RESULTS: Viruses were isolated from 16 (22.2%) of the 72 patients enrolled. The most commonly identified viruses were parainfluenza type 3, influenza A, and rhinovirus. A total of 30 (41.7%) patients had positive bacterial cultures, with the most commonly found bacteria being Haemophilus influenzae and Haemophilus parainfluenzae. Five patients (6.9%) had both positive sputum cultures and virus identification. The WBC, CRP, and PCT levels of the bacteria-positive and bacteria-negative groups were not statistically different. Multivariate analysis showed that patients with increased sputum volumes during the COPD exacerbations had higher risks of recurrent exacerbations in the 1-year period following the first exacerbation. CONCLUSION: WBC, CRP, or PCT could not differentiate between bacterial and viral infections in patients with COPD exacerbation requiring ED visits. Those with increased sputum during a COPD exacerbation had higher risks for recurrent exacerbations. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/25926728/Procalcitonin_and_C_reactive_protein_cannot_differentiate_bacterial_or_viral_infection_in_COPD_exacerbation_requiring_emergency_department_visits_ L2 - https://dx.doi.org/10.2147/COPD.S76740 DB - PRIME DP - Unbound Medicine ER -