The Value Of Serum Procalcitonin Level In Guiding The Use Of Antibiotic In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Background:Chronic obstructive pulmonary disease (COPD) is a kind of common and frequently encountered disease which seriously harms human health. The mortality of COPD is high and it has brought a heavy economic burden to patients and their families as well as the society. An investigation of 20245 adults in 7 regions in china showed the prevalence of COPD was as high as 8.2%among the over 40s.According to The Globe Burden of Disease Study, COPD will be the third place in the global cause of disease death by 2O20.What is more, The world bank and the World Health Organization's data show that by 2020, COPD will be ranked fifth in the world's disease economic burden of world disease. COPD is a lung disease characterized by persistent airflow limitation, which is progressive development, and its repeated acute attacks lead to the decline of lung function and quality of life. It has been revealed that about 50-60% of COPD acute exacerbation period(AECOPD) is caused by bacterial infection, but also by the virus, mycoplasma, fungal or non infectious factors. Even by the sputum culture of bacteria, it is difficult to distinguish between pathogens or bacteria. However, about 7O%-85% of AECOPD patients received antibiotic therapy, which can easily lead to the abuse of antibiotics and bacterial resistance. Clinicians usually determine whether bacterial infection exists according to the symptoms, signs, conventional inflammatory markers (such as:white blood cell count, erythrocyte sedimentation rate, C-reactive protein) and sputum examination results. Since the sensitivity and specificity of these inflammatory markers are not fine and the culture of sputum bacterial culture cost a lot of time, we hope to explore an inflammatory marker that may quickly and accurately determine the infection of AECOPD. Procalcitonin (PCT) is first detected in serum protein in septic patients in 1990s. In recent years, scientists have found that the concentration of PCT is almost exclusively elevated in the specific bacterial infection, while keeping basically normal in virus infection, tumor and other diseases, thus laying the foundation for our study.Objective:To investigate the value of serum procalcitonin (PCT) level in guiding the use of antibiotic in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:108 patients with AECOPD were divided into the PCT group (n=52) and the conventional treatment group (n=56) according to the mantissa of their admission number. Serum PCT levels in patients from the PCT group were measured in day 1,4, 7 and 10 after hospitalization, and decide whether use antibiotic according to the test result. In conventional treatment group, patients received antibiotics according to the clinical features and treatment guidelines of antibiotics.Results:There was no statistical significance in the clinical effective rate of moderate and severe patients between two groups, while the clinical effective rate of extremely severe patients in PCT group was lower significantly than that in conventional treatment group.The differences between two groups in the antibiotic utilization rate, duration of antibiotic therapy, hospitalization and medical expense were significant. The two groups'exacerbation times and time to next exacerbation were not significant within 6 months.Conclusion:Serum procalcitonin can guide the antibiotic treatment on the moderate and severe patients with AECOPD, and it can reduce the exposure of antibiotics.