Chest

Chest

Volume 131, Issue 4, April 2007, Pages 1058-1067
Journal home page for Chest

Original Research
COPD
Copeptin, C-Reactive Protein, and Procalcitonin as Prognostic Biomarkers in Acute Exacerbation of COPD

https://doi.org/10.1378/chest.06-2336Get rights and content

Background

A novel approach to estimate the severity of COPD exacerbation and predict its outcome is the use of biomarkers. We assessed circulating levels of copeptin, the precursor of vasopressin, C-reactive protein (CRP), and procalcitonin as potential prognostic parameters for in-hospital and long-term outcomes in patients with acute exacerbation of COPD (AECOPD) requiring hospitalization.

Methods

Data of 167 patients (mean age, 70 years; mean FEV1, 39.9 ± 16.9 of predicted [± SD]) presenting to the emergency department due to AECOPD were analyzed. Patients were evaluated based on clinical, laboratory, and lung function parameters on hospital admission, at 14 days, and at 6 months.

Results

Plasma levels of all three biomarkers were elevated during the acute exacerbation (p < 0.001), but levels at 14 days and 6 months were similar (p = not significant). CRP was significantly higher in patients presenting with Anthonisen type I exacerbation (p = 0.003). In contrast to CRP and procalcitonin, copeptin on hospital admission was associated with a prolonged hospital stay (p = 0.002) and long-term clinical failure (p < 0.0001). Only copeptin was predictive for long-term clinical failure independent of age, comorbidity, hypoxemia, and lung functional impairment in multivariate analysis (p = 0.005). The combination of copeptin and previous hospitalization for COPD increased the risk of poor outcome (p < 0.0001). Long-term clinical failure was observed in 11% of cases with copeptin < 40 pmol/L and no history of hospitalization, as compared to 73% of patients with copeptin ≥ 40 pmol/L and a history of hospitalization (p < 0.0001).

Conclusions

We suggest copeptin as a prognostic marker for short-term and long-term prognoses in patients with AECOPD requiring hospitalization.

Section snippets

Setting and Study Population

Data from 167 patients admitted for AECOPD to the emergency department of the University Hospital Basel, Switzerland from November 2003 to March 2005 and included in a randomized study was analyzed. A complete description has been reported elsewhere.29 In brief, the primary end point of the study was to evaluate the prescription and duration of antibiotic use in patients randomly assigned to procalcitonin guidance as compared to usual care. To be eligible for the study, patients had to be

Study Population

Detailed baseline characteristics of the study population are presented in Table 1. Eighty-seven percent of patients were receiving medical treatment for COPD on hospital admission, including inhaled β2-agonists (85%), anticholinergics (52%), inhaled steroids (72%), oral steroids (33%), theophylline (10%), and home oxygen (14%).

Cultures from sputum yielded pathogenic bacteria in 54 patients (32.2%). Gram-negative bacteria accounted for 69%, and Gram-positive organisms for 31% of all

Discussion

The frequency and severity of exacerbation are the most important factors determining overall prognosis in COPD.13839 Hence, accurate individual risk assessment at exacerbation is of pivotal importance for clinical management and rational allocation of medical resources in this large and ever-growing population. In comparison to CRP and procalcitonin, copeptin was superior to predict the course of exacerbation in our study population. We observed that elevated copeptin levels at hospital

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    Dr. B. Müller has served as consultant and received payments from BRAHMS (the manufacturer of procalcitonin and copeptin assays) to attend advisory board meetings and speaker engagements, or research. Dr. Morgenthaler and Dr. Struck are employees of BRAHMS. The other authors have no conflicts of interest to disclose.

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    Copyright © 2007 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.