SESSION TITLE: Outcomes in COPD
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 02:45 PM - 04:15 PM
PURPOSE: Clinical methods were created to find the subsets of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) that need antibiotics1,2 The goal is to decrease antibiotic use and its undesirable outcomes such as increased resistance1,2 Clinical Criterias as the Anthonisen are inexpensive and easy to do but rely on subject report and lack objectivity. Daniels et al. unveiled this weakness by proving that sputum color changes per patient report did not correlate with bacterial exacerbations6 Biomarkers, including Procalcitonin, were studied to overcome this obstacle.5 We conducted a meta-analysis of randomized controlled trials to assess the outcomes of a procalcitonin-guided antibiotic regimen.
METHODS: We electronically searched the terms “Chronic Obstructive Pulmonary Disease exacerbation” and “procalcitonin” using PubMed, CENTRAL, CINAHL, and EMBASE databases for RCTs, clinical trials and observational studies published between January 1960 and November 2015. We then calculated mantel haenszel and inverse variance, with 95% confidence intervals using the Random-effects model. Statistical analysis was done with the RevMan5 software.
RESULTS: Two separate reviewers agreed on three studies that met our inclusion criteria. We found that patients with AECOPD that received antibiotics based on elevated procalcitonin level (Total of 246 patients) compared to standard group (total of 250 patients) had favorable trend to increase survival (OR 0.67, 95% CI: 0.29 to 1.53. P=0.34, I2=0%), and less antibiotics utilization (std mean difference -0.45, 95% CI: -0.92 to 0.01. P=0.06, I2=64%) with no difference in length of stay (std mean difference -0.00, 95% CI: -0.23 to 0.23. P=0.97, I2=35%).
CONCLUSIONS: Patients with AECOPD might receive antibiotics - broad spectrum in debatable circumstances7- without clear indication of a bacterial etiology. Procalcitionin is commonly used to help in antibiotic decisions in different pathologies including sepsis and pneumonia. Trials were also done in AECOPD. We analyzed the data obtained from three RCTs, and found a favorable trend of survival and antibiotic consumption which did not reach a statistically significant point possibly due to small number of patients. Future randomized control trials with large numbers of participants might yield statistically significant results.
CLINICAL IMPLICATIONS: Procalcitonin may help decreasing antibiotic consumption for hospitalized patients with AECOPD with no negative effect on survival.
DISCLOSURE: The following authors have nothing to disclose: George Mansour, Mohsin Salih, Richa Kukreja, Renuga Vivekanandan, Lee Morrow
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