Procalcitonin: Is it a predictor of noninvasive positive pressure ventilation necessity in acute chronic obstructive pulmonary disease exacerbation?

Abstract

• Background: Acute exacerbations of chronic obstructive pulmonary disease (AeCOPD) are important causes of morbidity and mortality. In this study, we analyzed procalcitonin (PCT) levels in AeCOPD and stable period of COPD in order to evaluate usage of PCT in the prediction of the severity of AeCOPD, and its value on the planing of noninvasive positive pressure ventilation (NPPV).
• Materials and Methods: In this cross sectional study (2009-2010) 118 COPD patients were enrolled, 68 of them (58%) were in acute exacerbations (case group). The others had stabile COPD and they were defined as control group.
• Results: In case group the mean levels of PCT (0.19±0.02) C-Reactive Protein (44.7±5.92), erythrocyte sedimentation rate (28.4±2.65), white blood cell (9.4±0.43) and %neutrophils (69.9±1.22) were significantly higher than controls (P=0.0001). There was no difference between PCT levels based on stages of COPD. There were significiant differences in mean PCT levels according to type and severity of AeCOPD. Mean PCT level in hospitalized patients receiving NPPV was 0.36 ng/ml, while it was 0.15 ng/ml for those treated without NPPV (P=0.0001). PCT cut-off value for NPPV indication was determined to be 0.10 ng/ml.
• Conclusions: PCT levels were found to be higher in AeCOPD patients than in stable COPD patients, as expected. Also mean PCT levels increased especially in cases with severe AeCOPD and those receiving NPPV among them. In the present study, we determined a cut off value of PCT as 0.10 ng/ml as a predictor of necessity of NPPV in AeCOPD.
• Key words: Acute exacerbation, chronic obstructive pulmonary disease, procalcitonin, noninvasive positive pressure treatment