title: Serum Procalcitonin as a Biomarker for the Prediction of Bacterial Exacerbation and Mortality in Severe COPD Exacerbations Requiring Mechanical Ventilation.
abstract: BACKGROUND
  Procalcitonin (PCT) is being used as a marker of bacterial infections. Although there are several studies showing the diagnostic yield of PCT to differentiate bacterial involvement in chronic obstructive pulmonary disease exacerbations (COPDE), the prognostic yield of PCT in severe COPDE has been studied less.
  
  
  OBJECTIVE
  The primary aim was to determine whether the level of serum PCT at admission in severe COPDE serves as a prognostic biomarker for hospital mortality. The secondary aim was to determine the role of PCT in identifying a bacterial exacerbation.
  
  
  METHODS
  A total of 63 COPDE patients (median age 71 years; male 58.7%) were retrospectively analyzed from our intensive care unit database.
  
  
  RESULTS
  The hospital mortality rate was 23.8%. Admission PCT levels were higher in patients who died during hospitalization (0.66 vs. 0.17 ng/ml; p = 0.014). This association between hospital mortality and serum PCT level remained significant in a multivariate analysis; for every 1 ng/ml increase in PCT level, hospital mortality increased 1.85 times (odds ratio; 95% confidence interval: 1.07-3.19; p = 0.026). The optimal admission PCT threshold was 0.25 ng/ml in order to discern patients who had bacterial exacerbation with a sensitivity of 63%, a specificity of 67%, and a negative predictive value of 80%. The negative predictive value increased to 89% when both the admission and follow-up PCT levels remained <0.25 ng/ml.
  
  
  CONCLUSIONS
  This study shows that admission PCT levels have a prognostic importance in estimating hospital mortality among patients with severe COPDE. A PCT level <0.25 ng/ml at the time of admission and during follow-up is suggestive of the absence of a bacterial cause of COPDE.
authors.affiliation: Medical Intensive Care Unit, Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Begum
authors.initials: B
authors.lastname: Ergan
authors.forename: Ahmet Altay
authors.initials: AA
authors.lastname: Şahin
authors.forename: Arzu
authors.initials: A
authors.lastname: Topeli
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000097:blood / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000382:microbiology / Q000401:mortality* / Q000628:therapy; D012372:ROC Curve; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D002116:Calcitonin