Clinical features and c-reactive protein as predictors of bacterial exacerbations of COPD

Francis, Nick A., Gillespie, David ORCID: https://orcid.org/0000-0002-6934-2928, Wootton, Mandy, White, Patrick, Bates, Janine, Richards, Jennifer, Melbye, Hasse, Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631 and Butler, Christopher C 2020. Clinical features and c-reactive protein as predictors of bacterial exacerbations of COPD. International Journal of Chronic Obstructive Pulmonary Disease 2020 , pp. 3147-3158. 10.2147/COPD.S265674

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Abstract

Introduction: Identifying predictors of bacterial and viral pathogens in sputum from patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) may help direct management. Methods: We used data from a trial evaluating a C-reactive protein (CRP) point of care guided approach to managing COPD exacerbations in primary care. We used regression analyses to identify baseline clinical features, including CRP value in those randomized to testing, associated with bacterial, viral or mixed infections, defined by the presence of bacterial and viral pathogens in sputum, detected by culture or polymerase chain reaction (PCR), respectively. Results: Of 386 participants with baseline sputum samples, 79 (20.5%), 123 (31.9%), and 91 (23.6%) had bacterial, viral/atypical, and mixed bacterial/viral/atypical pathogens identified, respectively. Increasing sputum purulence assessed by color chart was associated with increased odds of finding bacterial and mixed (bacterial and viral/atypical) pathogens in sputum (area under the ROC curve (AUROC) for bacterial pathogens =0.739 (95% CI: 0.670, 0.808)). Elevated CRP was associated with increased odds of finding bacterial pathogens and mixed pathogens but did not significantly increase the AUROC for predicting bacterial pathogens over sputum color alone (AUROC for combination of sputum color and CRP = 0.776 (95% CI: 0.708, 0.843), p for comparison of models = 0.053). We found no association between the presence of sputum pathogens and other clinical or demographic features. Conclusion: Sputum purulence was the best predictor of sputum bacterial pathogens and mixed bacterial viral/atypical pathogens in patients with COPD exacerbations in our study. Elevated CRP was associated with bacterial pathogens but did not add to the predictive value of sputum purulence.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Centre for Trials Research (CNTRR)
Publisher:	Dove Medical Press
ISSN:	1178-2005
Date of First Compliant Deposit:	16 November 2021
Date of Acceptance:	23 September 2020
Last Modified:	22 May 2023 21:27
URI:	https://orca.cardiff.ac.uk/id/eprint/145537

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