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Original Research: COPD |

Pancreatic Stone Protein Predicts Positive Sputum Bacteriology in Exacerbations of COPDPancreatic Stone Protein in COPD Exacerbation

Andreas Scherr, MD; Rolf Graf, MD; Martha Bain, RN; Mirjam Christ-Crain, MD; Beat Müller, MD; Michael Tamm, MD, FCCP; Daiana Stolz, MD, MPH
Author and Funding Information

From the Clinic of Pulmonary Medicine and Respiratory Cell Research (Drs Scherr, Tamm, and Stolz), and Clinic of Endocrinology (Dr Christ-Crain), Diabetes and Clinical Nutrition, University Hospital, Basel; Pancreatitis Research Laboratory (Dr Graf and Ms Bain), University Hospital Zurich, Zurich; and the Medical University Clinic (Dr Müller), Kantonsspital Aarau AG, Aarau, Switzerland.

Correspondence to: Daiana Stolz, MD, MPH, Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; e-mail: dstolz@uhbs.ch


Funding/Support: Dr Stolz was supported by grants from the Swiss National Foundation [No. PP00-P3_128412/1]. Additional funding was granted by the Clinic of Pulmonary Medicine and Clinic of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland. Dr Christ-Crain was supported by grants from the Swiss National Foundation [No. PP00P3_123346].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(2):379-387. doi:10.1378/chest.12-0730
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Background:  Pancreatic stone protein/regenerating protein (PSP/reg) serum levels are supposed to be increased in bacterial inflammation. PSP/reg levels also might be useful, therefore, as a predictor of bacterial infection in COPD.

Methods:  Two hundred consecutive patients presenting to the ED due to acute exacerbation of COPD were prospectively assessed. Patients were evaluated based on clinical, laboratory, and lung functional parameters at admission (exacerbation) and after short-term follow-up (14-21 days). PSP/reg serum values were measured by a newly developed enzyme-linked immunosorbent assay.

Results:  PSP/reg levels were elevated in subjects with COPD exacerbation (23.8 ng/mL; 95% CI, 17.1-32.7) when compared with those with stable disease (19.1 ng/mL; 95% CI, 14.1-30.4; P = .03) and healthy control subjects (14.0 ng/mL; 95% CI, 12.0-19.0; P < .01). Higher PSP/reg values were observed in exacerbations with positive sputum bacteriology compared with those with negative sputum bacteriology (26.1 ng/mL [95% CI, 19.2-38.1] vs 20.8 ng/mL [95% CI, 15.6-27.2]; P < .01). Multivariate regression analysis revealed PSP/reg level as an independent predictor of positive sputum bacteriology. A combination of a PSP/reg cutoff value of > 33.9 ng/mL and presence of discolored sputum had a specificity of 97% to identify patients with pathogenic bacteria on sputum culture. In contrast, PSP/reg levels < 18.4 ng/mL and nonpurulent sputum ruled out positive bacterial sputum culture (sensitivity, 92%). In survival analysis, high PSP/reg levels at hospital admission were associated with increased 2-year mortality.

Conclusions:  Serum PSP/reg level might represent a promising new biomarker to identify bacterial etiology of COPD exacerbation.

Trial registry:  Current Controlled Trials Database; No.: ISRCTN-77261143; URL: http://www.controlled-trials.com/isrctn

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