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Relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of COPD
BACKGROUND: Acute exacerbations of COPD (AECOPD) and community acquired pneumonia (CAP) often coexist. Although chest radiographs may differentiate between these diagnoses, chest radiography is known to underestimate the incidence of CAP in AECOPD. In this exploratory study, we prospectively investi...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209851/ https://www.ncbi.nlm.nih.gov/pubmed/35747233 http://dx.doi.org/10.1183/23120541.00054-2022 |
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author | Prins, Hendrik J. Duijkers, Ruud Kramer, Gerdien Boerhout, Els Rietema, Floris J. de Jong, Pim A. Schoorl, Marianne I. van der Werf, Tjip S. Boersma, Wim G. |
author_facet | Prins, Hendrik J. Duijkers, Ruud Kramer, Gerdien Boerhout, Els Rietema, Floris J. de Jong, Pim A. Schoorl, Marianne I. van der Werf, Tjip S. Boersma, Wim G. |
author_sort | Prins, Hendrik J. |
collection | PubMed |
description | BACKGROUND: Acute exacerbations of COPD (AECOPD) and community acquired pneumonia (CAP) often coexist. Although chest radiographs may differentiate between these diagnoses, chest radiography is known to underestimate the incidence of CAP in AECOPD. In this exploratory study, we prospectively investigated the incidence of infiltrative changes using low-dose computed tomography (LDCT). Additionally, we investigated whether clinical biomarkers of CAP differed between patients with and without infiltrative changes. METHODS: Patients with AECOPD in which pneumonia was excluded using chest radiography underwent additional LDCT-thorax. The images were read independently by two radiologists; a third radiologist was consulted as adjudicator. C-reactive protein (CRP), procalcitonin (PCT), and serum amyloid A (SAA) at admission were assessed. RESULTS: Out of the 100 patients included, 24 had one or more radiographic abnormalities suggestive of pneumonia. The interobserver agreement between two readers (Cohen's κ) was 0.562 (95% CI 0.371–0.752; p<0.001). Biomarkers were elevated in the group with radiological abnormalities compared to the group without abnormalities. Median (interquartile range (IQR)) CRP was 76 (21.5–148.0) mg·L(−1) compared to 20.5 (8.8–81.5) mg·L (−1) (p=0.018); median (IQR) PCT was 0.09 (0.06–0.15) µg·L(−1) compared to 0.06 (0.04–0.08) μg·L(−1) (p=0.007); median (IQR) SAA was 95 (7–160) µg·mL(−1) compared to 16 (3–89) µg·mL(−1) (p=0.019). Sensitivity and specificity for all three biomarkers were moderate for detecting radiographic abnormalities by LDCT in this population. The area under the receiver operating characteristic curve was 0.66 (95% CI 0.52–0.80) for CRP, 0.66 (95% CI 0.53–0.80) for PCT and 0.69 (95% CI 0.57–0.81) for SAA. CONCLUSION: LDCT can detect additional radiological abnormalities that may indicate acute-phase lung involvement in patients with AECOPD without infiltrate(s) on the chest radiograph. Despite CRP, PCT and SAA being significantly higher in the group with radiological abnormalities on LDCT, they proved unable to reliably detect or exclude CAP. Further research is warranted. |
format | Online Article Text |
id | pubmed-9209851 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-92098512022-06-22 Relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of COPD Prins, Hendrik J. Duijkers, Ruud Kramer, Gerdien Boerhout, Els Rietema, Floris J. de Jong, Pim A. Schoorl, Marianne I. van der Werf, Tjip S. Boersma, Wim G. ERJ Open Res Original Research Articles BACKGROUND: Acute exacerbations of COPD (AECOPD) and community acquired pneumonia (CAP) often coexist. Although chest radiographs may differentiate between these diagnoses, chest radiography is known to underestimate the incidence of CAP in AECOPD. In this exploratory study, we prospectively investigated the incidence of infiltrative changes using low-dose computed tomography (LDCT). Additionally, we investigated whether clinical biomarkers of CAP differed between patients with and without infiltrative changes. METHODS: Patients with AECOPD in which pneumonia was excluded using chest radiography underwent additional LDCT-thorax. The images were read independently by two radiologists; a third radiologist was consulted as adjudicator. C-reactive protein (CRP), procalcitonin (PCT), and serum amyloid A (SAA) at admission were assessed. RESULTS: Out of the 100 patients included, 24 had one or more radiographic abnormalities suggestive of pneumonia. The interobserver agreement between two readers (Cohen's κ) was 0.562 (95% CI 0.371–0.752; p<0.001). Biomarkers were elevated in the group with radiological abnormalities compared to the group without abnormalities. Median (interquartile range (IQR)) CRP was 76 (21.5–148.0) mg·L(−1) compared to 20.5 (8.8–81.5) mg·L (−1) (p=0.018); median (IQR) PCT was 0.09 (0.06–0.15) µg·L(−1) compared to 0.06 (0.04–0.08) μg·L(−1) (p=0.007); median (IQR) SAA was 95 (7–160) µg·mL(−1) compared to 16 (3–89) µg·mL(−1) (p=0.019). Sensitivity and specificity for all three biomarkers were moderate for detecting radiographic abnormalities by LDCT in this population. The area under the receiver operating characteristic curve was 0.66 (95% CI 0.52–0.80) for CRP, 0.66 (95% CI 0.53–0.80) for PCT and 0.69 (95% CI 0.57–0.81) for SAA. CONCLUSION: LDCT can detect additional radiological abnormalities that may indicate acute-phase lung involvement in patients with AECOPD without infiltrate(s) on the chest radiograph. Despite CRP, PCT and SAA being significantly higher in the group with radiological abnormalities on LDCT, they proved unable to reliably detect or exclude CAP. Further research is warranted. European Respiratory Society 2022-06-20 /pmc/articles/PMC9209851/ /pubmed/35747233 http://dx.doi.org/10.1183/23120541.00054-2022 Text en Copyright ©The authors 2022 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org) |
spellingShingle | Original Research Articles Prins, Hendrik J. Duijkers, Ruud Kramer, Gerdien Boerhout, Els Rietema, Floris J. de Jong, Pim A. Schoorl, Marianne I. van der Werf, Tjip S. Boersma, Wim G. Relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of COPD |
title | Relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of COPD |
title_full | Relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of COPD |
title_fullStr | Relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of COPD |
title_full_unstemmed | Relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of COPD |
title_short | Relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of COPD |
title_sort | relationship between biomarkers and findings on low-dose computed tomography in hospitalised patients with acute exacerbation of copd |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209851/ https://www.ncbi.nlm.nih.gov/pubmed/35747233 http://dx.doi.org/10.1183/23120541.00054-2022 |
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