Chronic obstructive pulmonary disease (COPD) is a preventable and treatable, but progressive disease and hospital admissions of patients with COPD are frequently due to acute exacerbations. Recently, measurement of procalcitonin (PCT) levels appears to be useful in order to minimize this problem as acute phase reactants does not difference between bacterial and non-bacterial causes of inflammation. Aim; The aim of this study was to investigate whether the measurement of Procalcitonin can be used in the differentiation of bacterial and non-bacterial infectious causes of COPD exacerbation, thus helping in planning the treatment, reduce overuse of antibiotics in patients admitted with acute exacerbation of COPD thus reducing economic burden and decrease drug resistance. 86 patients with known COPD and admitted in emergency department with symptoms of acute exacerbation of COPD were included in this study after obtaining written informed consent. At presentation before putting antibiotics blood samples were taken for procalcitonin level, routine blood tests including sputum and blood culture. Patients were allocated in to three groups based on procalcitonin value. Group A; procalcitonin value below < 0.25 ng/ml. (normal) (n=57) Group B; procalcitonin value between 0.25- 0.5 ng/ml (local bacterial infection) (n=8) Group C; procalcitonin value between 0.5-2 ng/ml (systemic bacterial infection) (n=21) Results ; In our study a correlation was seen between procalcitonin value in each group and WBC count, fever, ESR, CRP, Vaccination, Chest X ray, smoking and microbiology i.e. blood and sputum culture. A significant correlation was seen between serum procalcitonin value and WBCCount, fever, chest x ray, CRP, blood and sputum culture. (P valve ≤ 0.0001) but no significant correlation was seen between serum procalcitonin level in each group with ESR which is one of acute phase reactant p valve 0.043 Conclusions: This study demonstrates that procalcitonin is a good marker for differentiation between bacterial and nonbacterial acute exacerbation of COPD and could be used to guide initiation and assessing response to antibiotic therapy in patients. Procalcitonin- guided antibiotic therapy has the potential to decrease unnecessary antibiotic use in nonbacterial COPD exacerbations, thereby decreasing the spread of antibiotic-resistant bacteria and reducing antibiotic[1]related adverse reactions.
