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Procalcitonin and C reactive protein in hospitalised adult patients with community acquired pneumonia, exacerbation of asthma and chronic obstructive pulmonary disease

Procalcitonin and C reactive protein in hospitalised adult patients with community acquired pneumonia, exacerbation of asthma and chronic obstructive pulmonary disease
Procalcitonin and C reactive protein in hospitalised adult patients with community acquired pneumonia, exacerbation of asthma and chronic obstructive pulmonary disease
Background:
Antibiotic overuse in respiratory illness is common and is associated with drug resistance and hospital-acquired infection. Biomarkers that can identify bacterial infections may reduce antibiotic prescription. We aimed to compare the usefulness of the biomarkers procalcitonin and C-reactive protein (CRP) in patients with pneumonia or exacerbations of asthma or COPD.

Methods:
Patients with a diagnosis of community-acquired pneumonia or exacerbation of asthma or COPD were recruited during the winter months of 2006 to 2008. Demographics, clinical data, and blood samples were collected. Procalcitonin and CRP concentrations were measured from available sera.

Results:
Sixty-two patients with pneumonia, 96 with asthma, and 161 with COPD were studied. Serum procalcitonin and CRP concentrations were strongly correlated (Spearman rank correlation coefficient [rs] = 0.56, P < .001). Patients with pneumonia had increased procalcitonin and CRP levels (median [interquartile range] 1.27 ng/mL [2.36], 191 mg/L [159]) compared with those with asthma (0.03 ng/mL [0.04], 9 mg/L [21]) and COPD (0.05 ng/mL [0.06], 16 mg/L [34]). The area under the receiver operating characteristic curve (95% CI) for distinguishing between patients with pneumonia (antibiotics required) and exacerbations of asthma (antibiotics not required), for procalcitonin and CRP was 0.93 (0.88-0.98) and 0.96 (0.93-1.00). A CRP value > 48 mg/L had a sensitivity of 91% (95% CI, 80%-97%) and specificity of 93% (95% CI, 86%-98%) for identifying patients with pneumonia.

Conclusions:
Procalcitonin and CRP levels can both independently distinguish pneumonia from exacerbations of asthma. CRP levels could be used to guide antibiotic therapy and reduce antibiotic overuse in hospitalized patients with acute respiratory illness.

0012-3692
1410-1418
Bafadhel, M.
0dc276f6-af92-412d-9163-aa0dbb967a8f
Clark, T.W.
712ec18e-613c-45df-a013-c8a22834e14f
Reid, C.
1a0e1971-649d-43da-8415-4e65d81e0c26
Medina, M.J.
46feda38-936b-4242-be2e-b3f78e214ddc
Batham, S.
3b04773b-1c79-4950-b515-8a6f4fbc6a89
Barer, M.R.
e71c5e05-53a4-49db-bec7-fff618adbd2b
Nicholson, K.G.
f5ee1433-1c07-4dc3-8a83-62d971f5ec3a
Brightling, C.E.
6d2574ad-2bd6-4241-bd4c-c9ac07a918a4
Bafadhel, M.
0dc276f6-af92-412d-9163-aa0dbb967a8f
Clark, T.W.
712ec18e-613c-45df-a013-c8a22834e14f
Reid, C.
1a0e1971-649d-43da-8415-4e65d81e0c26
Medina, M.J.
46feda38-936b-4242-be2e-b3f78e214ddc
Batham, S.
3b04773b-1c79-4950-b515-8a6f4fbc6a89
Barer, M.R.
e71c5e05-53a4-49db-bec7-fff618adbd2b
Nicholson, K.G.
f5ee1433-1c07-4dc3-8a83-62d971f5ec3a
Brightling, C.E.
6d2574ad-2bd6-4241-bd4c-c9ac07a918a4

Bafadhel, M., Clark, T.W., Reid, C., Medina, M.J., Batham, S., Barer, M.R., Nicholson, K.G. and Brightling, C.E. (2011) Procalcitonin and C reactive protein in hospitalised adult patients with community acquired pneumonia, exacerbation of asthma and chronic obstructive pulmonary disease. Chest, 139 (6), 1410-1418. (doi:10.1378/chest.10-1747). (PMID:109646)

Record type: Article

Abstract

Background:
Antibiotic overuse in respiratory illness is common and is associated with drug resistance and hospital-acquired infection. Biomarkers that can identify bacterial infections may reduce antibiotic prescription. We aimed to compare the usefulness of the biomarkers procalcitonin and C-reactive protein (CRP) in patients with pneumonia or exacerbations of asthma or COPD.

Methods:
Patients with a diagnosis of community-acquired pneumonia or exacerbation of asthma or COPD were recruited during the winter months of 2006 to 2008. Demographics, clinical data, and blood samples were collected. Procalcitonin and CRP concentrations were measured from available sera.

Results:
Sixty-two patients with pneumonia, 96 with asthma, and 161 with COPD were studied. Serum procalcitonin and CRP concentrations were strongly correlated (Spearman rank correlation coefficient [rs] = 0.56, P < .001). Patients with pneumonia had increased procalcitonin and CRP levels (median [interquartile range] 1.27 ng/mL [2.36], 191 mg/L [159]) compared with those with asthma (0.03 ng/mL [0.04], 9 mg/L [21]) and COPD (0.05 ng/mL [0.06], 16 mg/L [34]). The area under the receiver operating characteristic curve (95% CI) for distinguishing between patients with pneumonia (antibiotics required) and exacerbations of asthma (antibiotics not required), for procalcitonin and CRP was 0.93 (0.88-0.98) and 0.96 (0.93-1.00). A CRP value > 48 mg/L had a sensitivity of 91% (95% CI, 80%-97%) and specificity of 93% (95% CI, 86%-98%) for identifying patients with pneumonia.

Conclusions:
Procalcitonin and CRP levels can both independently distinguish pneumonia from exacerbations of asthma. CRP levels could be used to guide antibiotic therapy and reduce antibiotic overuse in hospitalized patients with acute respiratory illness.

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e-pub ahead of print date: 28 October 2010
Published date: June 2011
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 356774
URI: https://eprints.soton.ac.uk/id/eprint/356774
ISSN: 0012-3692
PURE UUID: 0171e8b0-1270-435a-8ae1-f96e5de8dd77
ORCID for T.W. Clark: ORCID iD orcid.org/0000-0001-6026-5295

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Date deposited: 25 Sep 2013 15:58
Last modified: 06 Jun 2018 12:23

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Contributors

Author: M. Bafadhel
Author: T.W. Clark ORCID iD
Author: C. Reid
Author: M.J. Medina
Author: S. Batham
Author: M.R. Barer
Author: K.G. Nicholson
Author: C.E. Brightling

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