The role of procalcitonin as a biomarker for acute pulmonary exacerbation in subjects with cystic fibrosis and non-cystic fibrosis bronchiectasis

Year 2022, , 164 - 171, 30.05.2022

Firuz Mammadov Sehnaz Olgun Yıldızelı Derya Kocakaya Huseyin Arıkan Caner Çınar Emel Eryuksel Berrin Ceyhan

https://doi.org/10.5472/marumj.1114952

Cited By: 1

Abstract

Objective: Patients with cystic fibrosis (CF) and non-CF bronchiectasis are prone to exacerbations of pulmonary infections. C-reactive
protein (CRP) and procalcitonin (PCT) are inflammatory markers. The aim of this study is to evaluate the role of CRP and PCT on
exacerbations of CF and non-CF bronchiectasis.

Patients and Methods: The medical records of 18 CF (52 hospitalizations) and 20 non-CF bronchiectasis patients (51 hospitalizations)
were reviewed retrospectively. CRP, PCT levels and, white blood cell (WBC) counts on admission and follow-up were evaluated.

Results: C-reactive protein levels correlated with PCT levels on admission in all patients. Baseline PCT levels were markedly higher
(>0.5µg/L) in 12% of CF and 10% of non-CF bronchiectasis patients, however, baseline CRP values were markedly higher (>5mg/L)
in 96% of CF and non-CF bronchiectasis patients (p=0.760 and p=0.100, respectively). Baseline CRP and PCT levels were positively
correlated with hospitalization length (r=0.501, p=0.001 and r=0.289, p=0.04, respectively) in CF patients, but not in non-CF
bronchiectasis.

Conclusion: Our study shows the potential utility of these biomarkers to determine the severity of the exacerbation particularly
predicting hospitalization length in CF patients. Both biomarkers could be able to guide antibiotic treatment of infective exacerbations
in CF and non-CF bronchiectasis patients

Keywords

Cystic fibrosis, Bronchiectasis, Exacerbation, Infection, Procalcitonin, C-reactive protein

References

• [1] Chmiel JF, Berger M, Konstan MW. The role of inflammation in the pathophysiology of CF lung disease. Clin Rev Allergy Immunol 2002; 23: 5-27. doi: 10.1385/CRIAI:23:1:005
• [2] Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med 2003; 168: 918-51. doi: 10.1164/ rccm.200304-505SO
• [3] Waters V, Ratjen F. Standard versus biofilm antimicrobial susceptibility testing to guide antibiotic therapy in cystic fibrosis. Cochrane Database Syst Rev 2012; 11: CD009528. doi: 10.1002/14651858.CD009528.pub2
• [4] Hsieh MH, Fang YF, Chen GY, et al. The role of the highsensitivity C-reactive protein in patients with stable noncystic fibrosis bronchiectasis. Pulm Med 2013; 2013: 795140. doi: 10.1155/2013/795140
• [5] Briel M, Christ-Crain M, Young J, et al. Procalcitoninguided antibiotic use versus a standard approach for acute respiratory tract infections in primary care: study protocol for a randomised controlled trial and baseline characteristics of participating general practitioners [ISRCTN73182671]. BMC Fam Pract 2005; 6: 34. doi: 10.1186/1471-2296-6-34
• [6] Glass S, Hayward C, Govan JR. Serum C-reactive protein in assessment of pulmonary exacerbations and antimicrobial therapy in cystic fibrosis. J Pediatr 1988; 113(1 Pt 1): 76-9. doi: 10.1016/s0022-3476(88)80533-x
• [7] Friesen CA, Wiens LA, Burry VF, Portnoy J, Roberts CC. C-reactive protein in acute pulmonary exacerbations of patients with cystic fibrosis. Pediatr Pulmonol 1995; 20: 215- 9. doi: 10.1002/ppul.195.020.0403
• [8] Christ-Crain M, Muller B. Procalcitonin in bacterial infections—hype, hope, more or less? Swiss Med Wkly 2005; 135(31-32): 451-60. doi: 2005/31/smw-11169
• [9] Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004; 39: 206-17. doi: 10.1086/421997
• [10] Gilbert DN. Procalcitonin as a biomarker in respiratory tract infection. Clin Infect Dis 2011; 52 Suppl 4: S346-50. doi: 10.1093/cid/cir050
• [11] Schuetz P, Muller B, Christ-Crain M, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 2012: CD007498. doi: 10.1002/14651858.CD007498.pub2
• [12] Louw JJ, Toelen J, Proesmans M, et al. Serum procalcitonin is not an early marker of pulmonary exacerbation in children with cystic fibrosis. Eur J Pediatr 2012; 171: 139-42. doi: 10.1007/s00431.011.1502-x
• [13] Roderfeld M, Rath T, Schulz R, et al. Serum matrix metalloproteinases in adult CF patients: Relation to pulmonary exacerbation. J Cyst Fibros 2009; 8: 338-47. doi: 10.1016/j.jcf.2009.06.001
• [14] Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017; 50: 1700629 . doi: 10.1183/13993.003.00629-2017
• [15] Loebinger MR, Shoemark A, Berry M, Kemp M, Wilson R. Procalcitonin in stable and unstable patients with bronchiectasis. Chron Respir Dis 2008; 5: 155-60. doi: 10.1177/147.997.2308088823
• [16] Fuchs HJ, Borowitz DS, Christiansen DH, et al. Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. The Pulmozyme Study Group. N Engl J Med 1994; 331: 637-42. doi: 10.1056/NEJM199.409.083311003
• [17] Hill AT, Haworth CS, Aliberti S, et al. Pulmonary exacerbation in adults with bronchiectasis: a consensus definition for clinical research. Eur Respir J 2017; 49. doi: 10.1183/13993.003.00051- 2017
• [18] Sethi S, Evans N, Grant BJ, Murphy TF. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002; 347: 465-71. doi: 10.1056/NEJMoa012561
• [19] Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006; 174: 84-93. doi: 10.1164/rccm.200.512.1922OC
• [20] Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 2007; 131: 9-19. doi: 10.1378/chest.06-1500
• [21] Shoki AH, Mayer-Hamblett N, Wilcox PG, Sin DD, Quon BS. Systematic review of blood biomarkers in cystic fibrosis pulmonary exacerbations. Chest 2013; 14: 1659-1670. doi: 10.1378/chest.13-0693
• [22] Horsley AR, Davies JC, Gray RD, et al. Changes in physiological, functional and structural markers of cystic fibrosis lung disease with treatment of a pulmonary exacerbation. Thorax 2013; 68: 532-9. doi: 10.1136/thoraxjnl-2012-202538
• [23] Loh G, Ryaboy I, Skabelund A, French A. Procalcitonin, erythrocyte sedimentation rate and C-reactive protein in acute pulmonary exacerbations of cystic fibrosis. Clin Respir J 2018; 12(4): 1545-1549. doi: 10.1111/crj.12703
• [24] Bailey KL, Murphy PJ, Lineberry OK, et al. Procalcitonin predicts the severity of cystic fibrosis pulmonary exacerbations and readmissions in adult patients: a prospective cohort study. J Investig Med 2020; 68: 856-863. doi: 10.1136/jim-2019- 001183
• [25] Sequeiros IM, Jarad NA. Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations. Chron Respir Dis 2012; 9: 213-20. doi: 10.1177/147.997.2312445903
• [26] Ito A, Ishida T, Tachibana H, Ito Y, Takaiwa T. Serial procalcitonin levels for predicting prognosis in communityacquired pneumonia. Respirology 2016; 21: 1459-64. doi: 10.1111/resp.12846