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Procalcitonin predicts the severity of cystic fibrosis pulmonary exacerbations and readmissions in adult patients: a prospective cohort study
  1. Kristina L Bailey1,2,
  2. Peter J Murphy2,
  3. Olena K Lineberry2,
  4. Matthew R Haack2,
  5. John D Dickinson2,
  6. Andre C Kalil3
  1. 1Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
  2. 2Int Med-Pulmonary, University of Nebraska Medical Center, Omaha, Nebraska, USA
  3. 3Int Med-Infectious Disease, University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Dr Kristina L Bailey, Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105-1850, USA; kbailey{at}unmc.edu

Abstract

Patients with cystic fibrosis (CF) experience multiple pulmonary exacerbations throughout their lifetime, resulting in repeated antibiotic exposure and hospital admissions. Reliable diagnostic markers to guide antibiotic treatment in patients with CF, however, are lacking. Given that the CF airway is characterized by persistent and frequent bacterial infection, our goal was to determine if procalcitonin (PCT) could be used as a severity and prognostic marker of CF exacerbation. We enrolled 40 participants at the time of diagnosis of CF pulmonary exacerbation. Inclusion criteria: age ≥19 years with exacerbation requiring antibiotics as determined by the treating physician. Exclusion criteria: antibiotics initiated more than 48 hours prior to enrollment, and pregnancy. Blood samples were collected on enrollment day and after 7–10 days of treatment. Of the 40 patients enrolled, 23 (57.5%) had detectable levels of PCT (≥0.05 ng/mL). PCT levels were significantly associated with pulmonary exacerbation scores (p=0.01) and per cent decrease in forced expiratory volume in 1 second (FEV1) (p=0.01) compared with the best in the last 12 months. Those who had worsening PCT during treatment had less improvement in FEV1 (p=0.001) and were more likely to be readmitted to the hospital sooner (p<0.0001). Likewise, those who had a detectable PCT at the time of admission were more likely to be readmitted sooner (p=0.03). PCT elevation during antibiotic treatment is associated with less improvement in FEV1 and earlier readmission. A detectable PCT level occurs only in more severe CF exacerbations. Multicenter trials are needed to confirm whether PCT may play a role in the clinical care of patients with CF.

  • inflammation
  • diagnostic tests, routine
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Footnotes

  • Contributors KLB assisted with study design, drafted, edited and approved the manuscript, oversaw writing and submission of the IRB protocol, consented patients, and analyzed the data. PJM edited and approved the manuscript, consented patients, and analyzed the data. OKL and MRH edited and approved the manuscript, helped write and submit the IRB protocol, consented patients, performed clinical assessments, generated data, and analyzed the data. JDD drafted, edited and approved the manuscript, and analyzed the data. ACK performed the procalcitonin assays, assisted with study design, drafted, edited and approved the manuscript, and analyzed the data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data from which the figures are composed are available upon reasonable peer request.

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