van de Geijn G-J M, Denker S, Meuleman-van Waning V, Koeleman H G M, Birnie E, Braunstahl G-J, Njo T L
Department of Clinical Chemistry (KCHL), Franciscus Gasthuis, Rotterdam, The Netherlands.
Department of Pulmonology/Internal Medicine, Franciscus Gasthuis, Rotterdam, The Netherlands.
Int J Lab Hematol. 2016 Dec;38(6):616-628. doi: 10.1111/ijlh.12550. Epub 2016 Jul 27.
Discriminating bacterial from nonbacterial acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is difficult, causing antibiotics overuse and bacterial resistance. Sputum cultures are of limited use because results take time. In our hospital, only leukocyte concentration and CRP are laboratory parameters evaluated in AECOPD. We evaluated additional tests to discriminate bacterial vs. nonbacterial AECOPD: 5-part leukocyte differentiation (hematology analyzer), leukocyte differentiation using flow cytometry (Leukoflow, Cytodiff), Leuko64 kit, and procalcitonin.
Retrospectively, patients were classified as bacterial or nonbacterial AECOPD. ROC analyses tested how the additional tests discriminate these groups.
Twenty-two AECOPD were classified as bacterial and 23 as nonbacterial. From the additional tests, basophil percentage (Cytodiff) has superior AUC (0.800). At a cutoff resulting in ≥90% sensitivity, neutrophil/lymphocyte ratio (AUC:0.755) and CD4-positive T cells (Leukoflow, AUC:0.747) have the highest specificity (57%). Both neutrophil mean volume and standard deviation (Cell Population Data, DxH800 hematology analyzer) had good combined sensitivity and specificity (AUC:0.846/0.804, 91% sensitivity, 69% specificity). Addition of leukocyte populations and procalcitonin to CRP in regression models (AUC: 0.907/0.876/0.890) increased specificity compared to CRP alone (71% or 73% vs. 39%).
No additional test has sufficient accuracy on its own to predict bacterial AECOPD. Combining CRP with several parameters from the additional tests may improve this.
区分慢性阻塞性肺疾病急性加重（AECOPD）的细菌性与非细菌性病因很困难，这导致了抗生素的过度使用和细菌耐药性。痰培养的作用有限，因为结果需要时间。在我们医院，AECOPD中仅评估白细胞浓度和CRP这两项实验室指标。我们评估了用于区分细菌性与非细菌性AECOPD的其他检测方法：五分类白细胞分化（血液分析仪）、流式细胞术白细胞分化（Leukoflow、Cytodiff）、Leuko64试剂盒和降钙素原。
回顾性地将患者分为细菌性或非细菌性AECOPD。ROC分析测试了这些额外检测方法对这些组别的区分能力。
22例AECOPD被分类为细菌性，23例为非细菌性。在这些额外检测方法中，嗜碱性粒细胞百分比（Cytodiff）的AUC最高（0.800）。在灵敏度≥90%的临界值下，中性粒细胞/淋巴细胞比值（AUC：0.755）和CD4阳性T细胞（Leukoflow，AUC：0.747）具有最高的特异性（57%）。中性粒细胞平均体积和标准差（细胞群体数据，DxH800血液分析仪）具有良好的综合灵敏度和特异性（AUC：0.846/0.804，灵敏度91%，特异性69%）。在回归模型中，将白细胞群体和降钙素原添加到CRP中（AUC：0.907/0.876/0.890），与单独使用CRP相比，特异性有所提高（71%或73%对39%）。
没有一种额外检测方法本身具有足够的准确性来预测细菌性AECOPD。将CRP与额外检测方法中的几个参数相结合可能会改善这一情况。
