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Clinical features and C-reactive protein as predictors of bacterial exacerbations of COPD

Clinical features and C-reactive protein as predictors of bacterial exacerbations of COPD
Clinical features and C-reactive protein as predictors of bacterial exacerbations of COPD

Introduction: identifying predictors of bacterial and viral pathogens in sputum from patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) may help direct management.

Methods: we used data from a trial evaluating a C-reactive protein (CRP) point of care guided approach to managing COPD exacerbations in primary care. We used regression analyses to identify baseline clinical features, including CRP value in those randomized to testing, associated with bacterial, viral or mixed infections, defined by the presence of bacterial and viral pathogens in sputum, detected by culture or polymerase chain reaction (PCR), respectively.

Results: of 386 participants with baseline sputum samples, 79 (20.5%), 123 (31.9%), and 91 (23.6%) had bacterial, viral/atypical, and mixed bacterial/viral/atypical pathogens identified, respectively. Increasing sputum purulence assessed by color chart was associated with increased odds of finding bacterial and mixed (bacterial and viral/atypical) pathogens in sputum (area under the ROC curve (AUROC) for bacterial pathogens =0.739 (95% CI: 0.670, 0.808)). Elevated CRP was associated with increased odds of finding bacterial pathogens and mixed pathogens but did not significantly increase the AUROC for predicting bacterial pathogens over sputum color alone (AUROC for combination of sputum color and CRP = 0.776 (95% CI: 0.708, 0.843), p for comparison of models = 0.053). We found no association between the presence of sputum pathogens and other clinical or demographic features.

Conclusion: sputum purulence was the best predictor of sputum bacterial pathogens and mixed bacterial viral/atypical pathogens in patients with COPD exacerbations in our study. Elevated CRP was associated with bacterial pathogens but did not add to the predictive value of sputum purulence.

Bacteria, COPD, Exacerbation, Infection, Primary care, Sputum
1176-9106
3147-3158
Francis, Nick A
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Gillespie, David
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Wootton, Mandy
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White, Patrick
aa8d0bb0-0a13-4c57-8b3b-e8fa19b46b93
Bates, Janine
290a69e6-4f81-4dbe-b270-30e4155ca576
Richards, Jennifer
f408985f-1aa2-401a-bfe7-36bc8544ca67
Melbye, Hasse
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Hood, Kerenza
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Butler, Christopher C
8bf4cace-c34a-4b65-838f-29c2be91e434
Francis, Nick A
9b610883-605c-4fee-871d-defaa86ccf8e
Gillespie, David
757dc8d5-cae7-49ed-b099-4b44c9b0ce2b
Wootton, Mandy
9a541164-9f2f-47f2-97d0-7f4994b004ba
White, Patrick
aa8d0bb0-0a13-4c57-8b3b-e8fa19b46b93
Bates, Janine
290a69e6-4f81-4dbe-b270-30e4155ca576
Richards, Jennifer
f408985f-1aa2-401a-bfe7-36bc8544ca67
Melbye, Hasse
be60ca95-b236-48e5-8eb9-c9a153d54a8f
Hood, Kerenza
14a61c0b-dc19-4218-a5f1-f62421eea9c8
Butler, Christopher C
8bf4cace-c34a-4b65-838f-29c2be91e434

Francis, Nick A, Gillespie, David, Wootton, Mandy, White, Patrick, Bates, Janine, Richards, Jennifer, Melbye, Hasse, Hood, Kerenza and Butler, Christopher C (2020) Clinical features and C-reactive protein as predictors of bacterial exacerbations of COPD. International Journal of Chronic Obstructive Pulmonary Disease, 15, 3147-3158. (doi:10.2147/COPD.S265674).

Record type: Article

Abstract

Introduction: identifying predictors of bacterial and viral pathogens in sputum from patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) may help direct management.

Methods: we used data from a trial evaluating a C-reactive protein (CRP) point of care guided approach to managing COPD exacerbations in primary care. We used regression analyses to identify baseline clinical features, including CRP value in those randomized to testing, associated with bacterial, viral or mixed infections, defined by the presence of bacterial and viral pathogens in sputum, detected by culture or polymerase chain reaction (PCR), respectively.

Results: of 386 participants with baseline sputum samples, 79 (20.5%), 123 (31.9%), and 91 (23.6%) had bacterial, viral/atypical, and mixed bacterial/viral/atypical pathogens identified, respectively. Increasing sputum purulence assessed by color chart was associated with increased odds of finding bacterial and mixed (bacterial and viral/atypical) pathogens in sputum (area under the ROC curve (AUROC) for bacterial pathogens =0.739 (95% CI: 0.670, 0.808)). Elevated CRP was associated with increased odds of finding bacterial pathogens and mixed pathogens but did not significantly increase the AUROC for predicting bacterial pathogens over sputum color alone (AUROC for combination of sputum color and CRP = 0.776 (95% CI: 0.708, 0.843), p for comparison of models = 0.053). We found no association between the presence of sputum pathogens and other clinical or demographic features.

Conclusion: sputum purulence was the best predictor of sputum bacterial pathogens and mixed bacterial viral/atypical pathogens in patients with COPD exacerbations in our study. Elevated CRP was associated with bacterial pathogens but did not add to the predictive value of sputum purulence.

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Accepted/In Press date: 23 September 2020
Published date: 1 December 2020
Additional Information: Funding Information: This study is a secondary analysis of data collected by a project funded by the NIHR Health T echnology Assessment Program (project number 12/33/12). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The work was undertaken with the support of: 1) The UK Clinical Research Collaboration (UKCRC) registered Clinical T rials Unit, the Centre for T rials Research, and funding from Health and Care Research W ales and Cancer Research UK, under the auspices of the UKCRC collaboration, is gratefully acknowledged, and; 2) The UK Clinical Research Collaboration (UKCRC) registered University of Oxford Primary Care and V accines Clinical T rials Collaborative. Funding Information: Nick A Francis reports grants from NIHR HT A, during the conduct of the study . David Gillespie reports grants from the National Institute for Health Research, during the conduct of the study . Janine Bates reports grants from NIHR HT A, during the conduct of the study . Kerenza Hood report grants from NIHR HT A, during the conduct of the study; and I am a member of three NIHR funding committees: HT A General Committee, HT A Funding Committee Policy Group and the Research Professors panel. Christopher C Butler reports grants from the National Institute for Health Research Health T echnology Assessment Programme, during the conduct of the study . The authors report no other potential conflicts of interest for this work. Publisher Copyright: © 2020 Francis et al. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
Keywords: Bacteria, COPD, Exacerbation, Infection, Primary care, Sputum

Identifiers

Local EPrints ID: 446647
URI: http://eprints.soton.ac.uk/id/eprint/446647
ISSN: 1176-9106
PURE UUID: b42f0748-8b86-4274-b3de-ff40f48d2017
ORCID for Nick A Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 17 Feb 2021 17:30
Last modified: 10 Jan 2022 03:19

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Contributors

Author: Nick A Francis ORCID iD
Author: David Gillespie
Author: Mandy Wootton
Author: Patrick White
Author: Janine Bates
Author: Jennifer Richards
Author: Hasse Melbye
Author: Kerenza Hood
Author: Christopher C Butler

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