Ability of procalcitonin to distinguish between bacterial and nonbacterial infection in severe acute exacerbation of chronic obstructive pulmonary syndrome in the ICU

Cédric Daubin; François Fournel; Fabrice Thiollière; Fabrice Daviaud; Michel Ramakers; Andréa Polito; Bernard Flocard; Xavier Valette; Damien Du Cheyron; Nicolas Terzi; Muriel Fartoukh; Stephane Allouche; Jean-Jacques Parienti; from the PROCALCIVIR and BPCTrea study group

doi:10.1186/s13613-021-00816-6

Ability of procalcitonin to distinguish between bacterial and nonbacterial infection in severe acute exacerbation of chronic obstructive pulmonary syndrome in the ICU

Ann Intensive Care. 2021 Mar 6;11(1):39. doi: 10.1186/s13613-021-00816-6.

Authors

Cédric Daubin¹, François Fournel², Fabrice Thiollière³, Fabrice Daviaud⁴, Michel Ramakers⁵, Andréa Polito^{6

7}, Bernard Flocard⁸, Xavier Valette⁹, Damien Du Cheyron⁹, Nicolas Terzi^{10

11}, Muriel Fartoukh¹², Stephane Allouche¹³, Jean-Jacques Parienti^{2

14}; from the PROCALCIVIR and BPCTrea study group

Affiliations

¹ Department of Medical Intensive Care, CHU de Caen, 14000, Caen, France. daubin-c@chu-caen.fr.
² Department of Biostatistics and Clinical Research, CHU de Caen, 14000, Caen, France.
³ Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, Hospices Civils de Lyon, France.
⁴ Department of Medial Intensive Care, Cochin University Hospital, Paris, France.
⁵ Department of Intensive Care Medicine, General Hospital, Saint Lô, France.
⁶ Service de Médecine Intensive Et Réanimation, General Intensive Care Unit, Hôpital Raymond Poincaré (APHP), Raymond Poincaré Hospital, Garches, France.
⁷ Laboratoire Infection & Inflammation, U1173 Université de Versailles SQY-Paris Saclay - INSERM, Garches, France.
⁸ Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
⁹ Department of Medical Intensive Care, CHU de Caen, 14000, Caen, France.
¹⁰ Department of Medical Intensive Care, CHU de Grenoble Alpes, 38000, Grenoble, France.
¹¹ INSERM, U1042, University of Grenoble-Alpes, HP2, 38000, Grenoble, France.
¹² Service de Medecine Intensive Reanimation, AP-HP, Sorbonne université, Hôpital Tenon, Groupe de Recherche Clinique CARMAS, collegium Gallilée, Paris, France.
¹³ Universite Caen Normandie, Medical School, EA 4650, Signalisation, Electrophysiologie et Imagerie des lésions d'Ischemie-reperfusion Myocardique, 14000, Caen, France.
¹⁴ EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Université Caen Normandie, Caen, France.

Abstract

Background: To assess the ability of procalcitonin (PCT) to distinguish between bacterial and nonbacterial causes of patients with severe acute exacerbation of COPD (AECOPD) admitted to the ICU, we conducted a retrospective analysis of two prospective studies including 375 patients with severe AECOPD with suspected lower respiratory tract infections. PCT levels were sequentially assessed at the time of inclusion, 6 h after and at day 1, using a sensitive immunoassay. The patients were classified according to the presence of a documented bacterial infection (including bacterial and viral coinfection) (BAC + group), or the absence of a documented bacterial infection (i.e., a documented viral infection alone or absence of a documented pathogen) (BAC- group). The accuracy of PCT levels in predicting bacterial infection (BAC + group) vs no bacterial infection (BAC- group) at different time points was evaluated by receiver operating characteristic (ROC) analysis.

Results: Regarding the entire cohort (n = 375), at any time, the PCT levels significantly differed between groups (Kruskal-Wallis test, p < 0.001). A pairwise comparison showed that PCT levels were significantly higher in patients with bacterial infection (n = 94) than in patients without documented pathogens (n = 218) (p < 0.001). No significant difference was observed between patients with bacterial and viral infection (n = 63). For example, the median PCT-H₀ levels were 0.64 ng/ml [0.22-0.87] in the bacterial group vs 0.24 ng/ml [0.15-0.37] in the viral group and 0.16 ng/mL [0.11-0.22] in the group without documented pathogens. With a c-index of 0.64 (95% CI; 0.58-0.71) at H₀, 0.64 [95% CI 0.57-0.70] at H₆ and 0.63 (95% CI; 0.56-0.69) at H₂₄, PCT had a low accuracy for predicting bacterial infection (BAC + group).

Conclusion: Despite higher PCT levels in severe AECOPD caused by bacterial infection, PCT had a poor accuracy to distinguish between bacterial and nonbacterial infection. Procalcitonin might not be sufficient as a standalone marker for initiating antibiotic treatment in this setting.

Keywords: Antibiotic stewardship; Chronic obstructive pulmonary disease; Community-acquired pneumonia; Procalcitonin; Respiratory tract infection; Viral infection.