Usefulness of Procalcitonin as a Prognostic Marker in Critically Ill Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

SESSION TITLE: COPD Exacerbations SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: The usefulness of procalcitonin (PCT) as a prognostic marker in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is controversial. The present study prospectively detected whether PCT measured on intensive care unit (ICU) admission is predictive of 28-day mortality in a cohort of critically ill patients with AECOPD. METHODS: A total of 90 consecutive patients with AECOPD admitted to the medical ICU in a tertiary university hospital, during a 37-month period between June 2012 and June 2015, were assessed. Patients with major surgery in a month were excluded. RESULTS: The median age was 76 yr (range, 43-89 yr; IQR, 69-81), and 87.8% of the patients were male. 28 patients required exclusively non-invasive ventilation, 44 required exclusively invasive ventilation, 8 required both non-invasive and invasive ventilation, and 10 required only oxygen therapy. The median level of PCT on ICU admission was 0.30ng/mL (range, 0.02-120.00ng/mL; IQR, 0.10-1.80ng/mL), and the median APACHE II score was 19 (range, 10-43). The 28-day mortality rate was 35.6%. The 28-day survivors did show significantly decreased levels of PCT compared with non-survivors (0.25 ng/mL [range, 0.02-120.00 ng/mL] vs. 0.56ng/mL [0.05-33.44 ng/mL], Z=−2.55, P=0.01). In prediction of 28-day mortality, the area under the curve (AUC) for PCT was 0.66 (95% confidence interval [CI], 0.55-0.77) and APACHE II score was 0.68 (95% CI, 0.55-0.81). AUC was 0.68 (95%CI, 0.55-0.81) when PCT was combined with APACHE II score. CONCLUSIONS: The 28-day survivors did show significantly decreased levels of PCT compared with non-survivors on ICU admission in critically ill patients with AECOPD in a medical ICU. PCT on ICU admission might be predictive for 28-day mortality in patients with AECOPD. Moreover, combining PCT with APACHE II score added little additional power in predicting 28-day mortality in this cohort of critically ill patients with AECOPD. CLINICAL IMPLICATIONS: The PCT level might be used as a predictor of 28-day mortality in critically ill patients with AECOPD in the medical ICU. Little additional power was added when PCT was combined with APACHE II score. DISCLOSURE: The following authors have nothing to disclose: Xubin Huang, Jun Zhang, Xinyan Huang, Yanzhu Chen, Mian Zeng No Product/Research Disclosure Information