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Original Research: COPD |

Procalcitonin vs C-Reactive Protein as Predictive Markers of Response to Antibiotic Therapy in Acute Exacerbations of COPD

Johannes M. A. Daniels, MD, PhD; Marianne Schoorl, MSc; Dominic Snijders, MD; Dirk L. Knol, PhD; René Lutter, PhD; Henk M. Jansen, MD, PhD; Wim G. Boersma, MD, PhD
Author and Funding Information

From the Department of Pulmonary Diseases (Drs Daniels, Snijders, and Boersma) and the Department of Clinical Chemistry, Haematology and Immunology (Ms Schoorl), Medical Centre Alkmaar, Alkmaar; the Department of Epidemiology and Biostatistics (Dr Knol), VU University Medical Center, Amsterdam; and the Department of Experimental Immunology (Dr Lutter) and the Department of Respiratory Medicine (Drs Lutter and Jansen), Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Corresponding author: Johannes (Hans) M. A. Daniels, MD, Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands; e-mail: j.daniels@vumc.nl


Funding/Support: This study was supported by an unrestricted grant from GlaxoSmithKline (The Netherlands).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1108-1115. doi:10.1378/chest.09-2927
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Background:  Rational prescription of antibiotics in acute exacerbations of COPD (AECOPD) requires predictive markers. We aimed to analyze whether markers of systemic inflammation can predict response to antibiotics in AECOPD.

Methods:  We used data from 243 exacerbations out of 205 patients from a placebo-controlled trial on doxycycline in addition to systemic corticosteroids for AECOPD. Clinical and microbiologic response, serum C-reactive protein (CRP) level (cutoffs 5 and 50 mg/L), and serum procalcitonin level (PCT) (cutoffs 0.1 and 0.25 μg) were assessed.

Results:  Potential bacterial pathogens were identified in the majority of exacerbations (58%). We found a modest positive correlation between PCT and CRP (r = 0.46, P < .001). The majority of patients (75%) had low PCT levels, with mostly elevated CRP levels. Although CRP levels were higher in the presence of bacteria (median, 33.0 mg/L [interquartile range, 9.75-88.25] vs 17 mg/L [interquartile range, 5.0-61.0] [P = .004]), PCT levels were similar. PCT and CRP performed similarly as markers of clinical success, and we found a clinical success rate of 90% in patients with CRP ≤ 5 mg/L. A significant effect of doxycycline was observed in patients with a PCT level < .1 μg/L (treatment effect, 18.4%; P = .003). A gradually increasing treatment effect of antibiotics (6%, 10%, and 18%), although not significant, was found for patients with CRP values of ≤ 5, 6-50, and > 50 mg/L, respectively.

Conclusions:  Contrary to the current literature, this study suggests that patients with low PCT values do benefit from antibiotics. CRP might be a more valuable marker in these patients.

Trial registry:  ClinicalTrials.gov; No.: NCT00170222; URL: clinicaltrials.gov

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