Biomarkers to guide the use of antibiotics for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis
Biomarkers to guide the use of antibiotics for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis
BACKGROUND: Antibiotics are frequently prescribed for acute exacerbations of COPD (AECOPD) even though most do not have a bacterial aetiology. Biomarkers may help clinicians target antibiotic use by identifying AECOPD caused by bacterial pathogens. We aimed to summarise current evidence on the diagnostic accuracy of biomarkers for detecting bacterial versus non-bacterial AECOPD.
METHODS: We searched Embase and Medline using a search strategy including terms for COPD, biomarkers and bacterial infection. Data regarding diagnostic accuracy for each biomarker in predicting bacterial cause of exacerbation were extracted and summarised. We used to QUADAS-2 tool to assess risk of bias.
RESULTS: Of 509 papers identified, 39 papers evaluating 61 biomarkers were eligible for inclusion. Moderate quality evidence was found for associations between serum C-reactive protein (CRP), serum procalcitonin (PCT), sputum interleukin (IL)-8 and sputum tumour necrosis factor alpha (TNF-α), and the presence of bacterial pathogens in the sputum of patients with AECOPD. Having bacterial pathogens was associated with a mean difference (higher) CRP and PCT of 29.44 mg/L and 0.76 ng/mL respectively. There was inconsistent or weak evidence for associations between bacterial AECOPD and higher levels of sputum IL-1β, IL-6, myeloperoxidase (MPO) and neutrophil elastase (NE). We did not find any consistent evidence of diagnostic value for other biomarkers.
CONCLUSIONS: There is moderate evidence from heterogeneous studies that serum CRP and PCT are of value in differentiating bacterial from non-bacterial AECOPD, and little evidence for other biomarkers. Further high-quality research on the role of biomarkers in identifying bacterial exacerbations is needed.
Anti-Bacterial Agents/therapeutic use, Bacteria, Biomarkers, C-Reactive Protein/metabolism, Disease Progression, Humans, Procalcitonin, Pulmonary Disease, Chronic Obstructive/diagnosis
194
Hoult, George
10a7d059-a8a4-4409-a12f-cfab834e0b7a
Gillespie, David
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Wilkinson, Tom M A
8c55ebbb-e547-445c-95a1-c8bed02dd652
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Francis, Nick A
9b610883-605c-4fee-871d-defaa86ccf8e
13 May 2022
Hoult, George
10a7d059-a8a4-4409-a12f-cfab834e0b7a
Gillespie, David
a1389d8b-011c-408e-8064-2ce4ccf3312a
Wilkinson, Tom M A
8c55ebbb-e547-445c-95a1-c8bed02dd652
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Francis, Nick A
9b610883-605c-4fee-871d-defaa86ccf8e
Hoult, George, Gillespie, David, Wilkinson, Tom M A, Thomas, Mike and Francis, Nick A
(2022)
Biomarkers to guide the use of antibiotics for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis.
BMC Pulmonary Medicine, 22 (1), , [194].
(doi:10.1186/s12890-022-01958-4).
Abstract
BACKGROUND: Antibiotics are frequently prescribed for acute exacerbations of COPD (AECOPD) even though most do not have a bacterial aetiology. Biomarkers may help clinicians target antibiotic use by identifying AECOPD caused by bacterial pathogens. We aimed to summarise current evidence on the diagnostic accuracy of biomarkers for detecting bacterial versus non-bacterial AECOPD.
METHODS: We searched Embase and Medline using a search strategy including terms for COPD, biomarkers and bacterial infection. Data regarding diagnostic accuracy for each biomarker in predicting bacterial cause of exacerbation were extracted and summarised. We used to QUADAS-2 tool to assess risk of bias.
RESULTS: Of 509 papers identified, 39 papers evaluating 61 biomarkers were eligible for inclusion. Moderate quality evidence was found for associations between serum C-reactive protein (CRP), serum procalcitonin (PCT), sputum interleukin (IL)-8 and sputum tumour necrosis factor alpha (TNF-α), and the presence of bacterial pathogens in the sputum of patients with AECOPD. Having bacterial pathogens was associated with a mean difference (higher) CRP and PCT of 29.44 mg/L and 0.76 ng/mL respectively. There was inconsistent or weak evidence for associations between bacterial AECOPD and higher levels of sputum IL-1β, IL-6, myeloperoxidase (MPO) and neutrophil elastase (NE). We did not find any consistent evidence of diagnostic value for other biomarkers.
CONCLUSIONS: There is moderate evidence from heterogeneous studies that serum CRP and PCT are of value in differentiating bacterial from non-bacterial AECOPD, and little evidence for other biomarkers. Further high-quality research on the role of biomarkers in identifying bacterial exacerbations is needed.
Text
s12890-022-01958-4 (1)
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Accepted/In Press date: 18 April 2022
Published date: 13 May 2022
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© 2022. The Author(s).
Keywords:
Anti-Bacterial Agents/therapeutic use, Bacteria, Biomarkers, C-Reactive Protein/metabolism, Disease Progression, Humans, Procalcitonin, Pulmonary Disease, Chronic Obstructive/diagnosis
Identifiers
Local EPrints ID: 470276
URI: http://eprints.soton.ac.uk/id/eprint/470276
ISSN: 1471-2466
PURE UUID: 9b0ac906-b978-4975-903b-98c85ac62d65
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Date deposited: 05 Oct 2022 16:42
Last modified: 17 Mar 2024 03:58
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Author:
George Hoult
Author:
David Gillespie
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