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

Nick A. Francis; David Gillespie; Mandy Wootton; Patrick White; Janine Bates; Jennifer Richards; Hasse Melbye; Kerenza Hood; Christopher C. Butler

doi:10.2147/COPD.S265674

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

Nick A. Francis^*, David Gillespie, Mandy Wootton, Patrick White, Janine Bates, Jennifer Richards, Hasse Melbye, Kerenza Hood, Christopher C. Butler

^*Corresponding author for this work

Population Health Sciences

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

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 identi-fied, 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.

Original language	English
Pages (from-to)	3147-3158
Number of pages	12
Journal	International Journal of COPD
Volume	15
DOIs	https://doi.org/10.2147/COPD.S265674
Publication status	Published - 2020

Keywords

Bacteria
COPD
Exacerbation
Infection
Primary care
Sputum

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2147/COPD.S265674

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@article{754ed17e23e04c23a09c70c046ab5fa4,

title = "Clinical features and c-reactive protein as predictors of bacterial exacerbations of copd",

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 identi-fied, 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.",

keywords = "Bacteria, COPD, Exacerbation, Infection, Primary care, Sputum",

author = "Francis, {Nick A.} and David Gillespie and Mandy Wootton and Patrick White and Janine Bates and Jennifer Richards and Hasse Melbye and Kerenza Hood and Butler, {Christopher C.}",

year = "2020",

doi = "10.2147/COPD.S265674",

language = "English",

volume = "15",

pages = "3147--3158",

journal = "International Journal of COPD",

issn = "1176-9106",

publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - Clinical features and c-reactive protein as predictors of bacterial exacerbations of copd

AU - Francis, Nick A.

AU - Gillespie, David

AU - Wootton, Mandy

AU - White, Patrick

AU - Bates, Janine

AU - Richards, Jennifer

AU - Melbye, Hasse

AU - Hood, Kerenza

AU - Butler, Christopher C.

PY - 2020

Y1 - 2020

N2 - 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 identi-fied, 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.

AB - 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 identi-fied, 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.

KW - Bacteria

KW - COPD

KW - Exacerbation

KW - Infection

KW - Primary care

KW - Sputum

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U2 - 10.2147/COPD.S265674

DO - 10.2147/COPD.S265674

M3 - Article

C2 - 33293804

AN - SCOPUS:85097515971

SN - 1176-9106

VL - 15

SP - 3147

EP - 3158

JO - International Journal of COPD

JF - International Journal of COPD

ER -

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

Abstract

Keywords

UN SDGs

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