Evaluation and Correlation of Serum C-Reactive Protein and Procalcitonin Levels in Acute Exacerbation and Stable Phase of Chronic Obstructive Pulmonary Disease Patients: An Observational Study
Correspondence Address :
Dr. Manisha Bhardwaj,
Assistant Professor, Department of Pulmonary Medicine, Shri Lal Bahadur Shastri
Medical Government College and Hospital Mandi at Ner Chowk, Mandi-175021,
Himachal Pradesh, India.
E-mail: mbgmch@gmail.com
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterised by limitation of airflow that is not fully reversible. Acute exacerbations lead to worsening of respiratory symptoms which results in increased hospitalisation incurring high socio-economic costs. Timely diagnosis and early treatment of exacerbation can avoid unnecessary hospitalisation and mortality. Biomarkers which may function as diagnostic and prognostication aids are of great help in resource constrained countries like India. Indian literature on the role of biomarkers in such context are scarce.
Aim: To evaluate serum levels of C-Reactive Protein (CRP) and Procalcitonin (PCT) in COPD patients admitted in respiratory ward with acute exacerbation and assess their correlation with course of disease.
Materials and Methods: The present study was an observational study in which a total of 103 COPD patients, diagnosed as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines admitted with acute exacerbation, were included in the study. All patients were subjected to routine investigations at admission. The serum CRP and PCT levels were assessed at the time of admission, discharge and at four weeks after discharge as well. Normality of quantitative data was checked by measures of Kolmogorov-Smirnov tests of normality. For normally distributed data means were compared using unpaired t-test. For skewed data or scores Mann-Whitney Test was applied. For categorical variables, numbers and percentages were calculated. The data observed at various points of time was compared using Wilcoxon Signed-Rank test or paired t-test whichever was applicable depending on its normality. Correlation analysis was performed using Spearman’s Rank Test. All calculations were two-sided and were performed using Statistical Package for the Social Sciences (SPSS) trial version 17.0 (SPSS, Chicago, IL). A p-value of <0.05 was considered to indicate statistical significance.
Results: Serum levels of CRP and PCT measured were as follows; 10.80±21.1 mg/L, 7.40±8.9 mg/L and 3.50±6.20 mg/L (mean±standard deviation) and 0.08±0.11 mg/L, 0.05±0.70 mg/L, and 0.01±0.04 mg/L (mean±standard deviation) at admission, discharge and follow-up, respectively. The CRP and PCT levels were significantly higher at the time of admission than at discharge and follow-up (p-value ≤0.001, p-value ≤0.001) which correlated with severity of breathlessness as per Modified Medical Research Council (mMRC) dyspnoea scale. A significant correlation between CRP and PCT values was found at the time of admission (r=0.423, p-value ≤0.001) and at discharge (r=0.310, p-value ≤0.001) but not at follow-up (r=0.049, p-value=0.622).
Conclusion: The serum levels of CRP and PCT dropped significantly from admission to discharge and then follow-up after one month. The change in these parameters correlated well with exacerbation and stable phases of COPD. Further research is required to validate their role as biomarkers of acute exacerbation of COPD.
Biomarkers, Breathlessness, Modified medical research council dyspnoea scale
DOI: 10.7860/JCDR/2021/52498.15756
Date of Submission: Sep 21, 2021
Date of Peer Review: Oct 22, 2021
Date of Acceptance: Nov 30, 2021
Date of Publishing: Dec 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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