Comparison of the value of different biomarkers as diagnostic and prognostic markers in AECOPD

Background: Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) are a significant cause of admissions to emergency departments (ED) and play a key role in morbidity and mortality rates on a global scale. Patients with AECOPD are frequently treated by emergency medicine (EM) physicians who must accurately predict the severity and potential outcomes of these cases. Treatment decisions and the extent of intervention provided often hinge on these predictions. In our study, we aimed to evaluate and compare the efficacy of different biomarkers—Procalcitonin (PCT), Pro-Brain Natriuretic Peptide (Pro-BNP) and C-Reactive Protein (CRP)—in determining the severity and prognosis of AECOPD. Methods: We examined the data of 196 selected patients diagnosed with AECOPD who were admitted to our ED between 15 February 2023 and 15 February 2024. The Receiver Operating Characteristic (ROC) curve was used to demonstrate the sensitivity and specificity of the relevant biomarkers. Results: Pro-BNP was found to be a significant predictor for severe AECOPD at ≥1350 ng/L and for mortality at ≥1500 ng/L (the area under curve (AUC): 0.653, 0.758). PCT showed lower predictive performance for mortality compared to Pro-BNP (AUC: 0.627). Although CRP levels were elevated in both severity and mortality groups, it did not demonstrate significant differences in predicting disease severity or mortality. Conclusions: Pro-BNP and PCT hold promise as crucial biomarkers for the management of AECOPD. They could enable prompt initiation of advanced treatment and enhance the overall care for individuals with AECOPD. Clinical Trial Registration: The study was registered on ClinicalTrials.gov (NCT06514599).

Chronic obstructive pulmonary disease; Exacerbations; Pro-BNP; Procalcitonin

[1] Boers E, Barrett M, Su JG, Benjafield AV, Sinha S, Kaye L, et al. Global burden of chronic obstructive pulmonary disease through 2050. Jama Network Open. 2023; 6: e2346598.

[2] Global Initiative for Chronic Obstructive Lung Disease. 2024 GOLD report: global strategy for the diagnosis, management, and prevention of COPD. 2024. Available at: https://goldcopd.org/2024-gold-report/ (Accessed: 05 March 2024).

[3] GBD Chronic Respiratory Disease Collaborators. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Respiratory Medicine. 2020; 8: 585–596.

[4] Zhu N, Lin S, Wang L, Kong X, Huang W, Cao C. Elevated inflammatory burden index increases mortality in adults with chronic inflammatory airway diseases: a nationwide cohort study. BMC Pulmonary Medicine. 2024; 24: 399.

[5] GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020; 396: 1204–1222.

[6] Whittaker H, Rothnie KJ, Quint JK. Cause-specific mortality in COPD subpopulations: a cohort study of 339 647 people in England. Thorax. 2024; 79: 202–208.

[7] Pantzaris ND, Spilioti DX, Psaromyalou A, Koniari I, Velissaris D. The use of serum procalcitonin as a diagnostic and prognostic biomarker in chronic obstructive pulmonary disease exacerbations: a literature review update. Journal of Clinical Medicine Research. 2018; 10: 545–551.

[8] Hoult G, Gillespie D, Wilkinson TMA, Thomas M, Francis NA. Biomarkers to guide the use of antibiotics for acute exacerbations of COPD (AECOPD): a systematic review and meta-analysis. BMC Pulmonary Medicine. 2022; 22: 194.

[9] Davies AJ, Blessing PW, Eilbert WP. Measurement of procalcitonin as an indicator of severity in patients with chronic obstructive pulmonary disease admitted with respiratory illness. Cureus. 2022; 14: e28511.

[10] Lin SH, He YP, Lian JJ, Chu CK. Procalcitonin kinetics to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: procalcitonin’s adjunct role. Libyan Journal of Medicine. 2021; 16: 1961382.

[11] Gong C, Yang Y, Chen M, Xie Z. Effect of procalcitonin on the prognosis of patients with COPD. Biomedical Reports. 2020; 12: 313–318.

[12] Mariniello DF, D’Agnano V, Cennamo D, Conte S, Quarcio G, Notizia L, et al. Comorbidities in COPD: current and future treatment challenges. Journal of Clinical Medicine. 2024; 13: 743.

[13] Tian F, Song W, Wang L, Zeng Q, Zhao Z, Feng N, et al. NT-pro BNP in AECOPD-PH: old biomarker, new insights-based on a large retrospective case-controlled study. Respiratory Research. 2021; 22: 321.

[14] Zhang X, Zhou Q, Wang S, Ma Q, Sun Y. Etiology of emergency visit and in-hospital outcomes of patients with COPD. Emergency Medicine International. 2022; 2022: 8247133.

[15] Pavasini R, Tavazzi G, Biscaglia S, Guerra F, Pecoraro A, Zaraket F, et al. Amino terminal pro brain natriuretic peptide predicts all-cause mortality in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis. Chronic Respiratory Disease. 2017; 14: 117–126.

[16] Triantafyllidou C, Effraimidis P, Vougas K, Agholme J, Schimanke M, Cederquist K. The role of early warning scoring systems NEWS and MEWS in the acute exacerbation of COPD. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine. 2023; 17: 11795484231152305.