Tanrıverdi Hakan, Örnek Tacettin, Erboy Fatma, Altınsoy Bülent, Uygur Fırat, Atalay Figen, Tor Müge Meltem
Faculty of Medicine, Chest Diseases Department, Bülent Ecevit University, Esenköy, Kozlu, 67100, Zonguldak, Turkey.
Wien Klin Wochenschr. 2015 Oct;127(19-20):756-63. doi: 10.1007/s00508-014-0690-6. Epub 2015 Jan 14.
Viral or bacterial upper respiratory infections are the most common cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Based on available data, no reliable parameter has been presented to distinguish between bacterial and nonbacterial exacerbations. Therefore, we compared the diagnostic value of procalcitonin (PCT) level, which is a newer marker for predicting bacterial infections in patients with AECOPD, to routine parameters such as C-reactive protein (CRP) levels and the neutrophil/lymphocyte (N/L) ratio.
This study included all consecutive patients who were admitted for a diagnosis of AECOPD between January 1 and March 31, 2014. PCT, CRP, and the N/L ratio were assessed in addition to cultures from tracheal aspirates or sputum on the first day of admission. Patients with a pneumonic infiltration on chest radiographs, or an extrapulmonary infection focus, or whose blood samples were not obtained for PCT and/or CRP at the same time as sputum culture were excluded from the study.
A total of 77 patients were included with a mean age of 71.7 ± 9.5 years. Bacteria were isolated in 37.4 % of the patients. Mean PCT levels were significantly higher in patients with positive sputum cultures than in patients with negative sputum cultures. The cut-off values for PCT, CRP, and the N/L ratio for predicting a bacterial infection were 0.40 ng/mL, 91.50 mg/L, and 11.5, respectively; sensitivity was 61, 54, and 61 % respectively; specificity was 67, 52, and 58 %, respectively; and the area under the curve (AUC) values were 0.64, 0.52, and 0.58, respectively. The AUC value of PCT was significantly better for predicting bacterial infection compared with the CRP level or the N/L ratio (p = 0.042).
PCT was better than CRP and the N/L ratio for predicting a bacterial infection in hospitalized patients with AECOPD. However, we find PCT not so reliable in predicting bacterial infection in AECOPD due to sensitivity and specificity of less than 80 % and a low AUC value.
病毒或细菌引起的上呼吸道感染是慢性阻塞性肺疾病急性加重（AECOPD）最常见的病因。根据现有数据，尚无可靠参数可区分细菌感染和非细菌感染导致的病情加重。因此，我们将降钙素原（PCT）水平（一种用于预测AECOPD患者细菌感染的新型标志物）的诊断价值与常规参数如C反应蛋白（CRP）水平和中性粒细胞/淋巴细胞（N/L）比值进行了比较。
本研究纳入了2014年1月1日至3月31日期间因AECOPD诊断入院的所有连续患者。入院第一天除了对气管吸出物或痰液进行培养外，还评估了PCT、CRP和N/L比值。胸部X光片有肺炎浸润、肺外感染灶或在进行痰培养时未同时采集PCT和/或CRP血样的患者被排除在研究之外。
共纳入77例患者，平均年龄71.7±9.5岁。37.4%的患者分离出细菌。痰培养阳性患者的平均PCT水平显著高于痰培养阴性患者。预测细菌感染的PCT、CRP和N/L比值的临界值分别为0.40 ng/mL、91.50 mg/L和11.5；敏感性分别为61%、54%和61%；特异性分别为67%、52%和58%；曲线下面积（AUC）值分别为0.64、0.52和0.58。与CRP水平或N/L比值相比，PCT的AUC值在预测细菌感染方面显著更好（p = 0.042）。
对于住院的AECOPD患者，PCT在预测细菌感染方面优于CRP和N/L比值。然而，由于敏感性和特异性均低于80%且AUC值较低，我们发现PCT在预测AECOPD细菌感染方面并非十分可靠。
