Pancreatic stone protein predicts positive sputum bacteriology in exacerbations of COPD.
Chest. 2012 Aug 20;
Authors: Scherr1 A, Graf2 R, Bain2 M, Christ-Crain3 M, Müller4 B, Tamm1 M, Stolz1 D
Abstract
ABSTRACT BACKGROUND: Pancreatic Stone Protein/regenerating protein (PSP/reg) is supposed to be increased in bacterial inflammation. PSP/reg might therefore be also useful as a predictor of bacterial infection in COPD. METHODS: 200 consecutive patients presenting to the emergency department due to acute exacerbation of COPD were prospectively assessed. Patients were evaluated based on clinical, laboratorial and lung-functional parameters at admission (exacerbation) and after short term follow-up (14-21 days). PSP/reg serum values were measured by a new developed enzyme linked immunosorbent assay (ELISA). RESULTS: PSP/reg levels were elevated in subjects with COPD exacerbation (23.8 ng/ml 95% CI [17.1-32.7]) when compared to those with stable disease (19.1 ng/ml 95% CI [14.1-30.4], p=0.03) and healthy controls (14.0 ng/ml [12.0-19.0], p<0.01). Higher PSP/reg values were observed in exacerbations with positive as compared to those with negative sputum bacteriology (26.1 ng/ml 95% CI [19.2-38.1] vs. 20.8 ng/ml [15.6-27.2], p<0.01). Multivariate regression analysis revealed PSP/reg as independent predictor of positive sputum bacteriology. A combination of a PSP/reg cut-off of >33.9 ng/ml and presence of discolored sputum had a specifity of 97% to identify patients with pathogen bacteria on sputum culture. In contrast, PSP/reg levels <18.4 ng/ml and non-purulent sputum ruled widely out positive bacterial sputum culture (sensitivity 92%). In survival analysis, high PSP/reg levels at hospital admission were associated with increased 2-year mortality. CONCLUSIONS: PSP/reg might represent a promising new biomarker to identify bacterial etiology of COPD exacerbation.1Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Switzerland2Pancreatitis Research Laboratory, University Hospital Zuerich, Switzerland3Clinic of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Switzerland4Medical University Clinic, Kantonsspital Aarau AG, Aarau, SwitzerlandCorrespondence to: Prof. Daiana Stolz, MD, MPH, Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland E- mail: dstolz@uhbs.ch.
PMID: 22922487 [PubMed - as supplied by publisher]