Procalcitonin as a prognostic factor in patients with acute exacerbation of COPD without pneumonia: a prospective multicenter cohort study
11 affiliations
- 1Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University , , ,
- 2Center of Infectious Diseases, Division of Infectious Diseases in State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , , ,
- 3State Key Laboratory of Respiratory Disease, Guangzhou Medical University , , ,
- 4Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan , , ,
- 5Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine , , ,
- 6Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , , ,
- 7Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , , ,
- 8Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Neijiang City , , ,
- 9Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University , , ,
- 10Department of Emergency, First People's Hospital of Jiujiang , , ,
- 11Sichuan Cancer Hospital, University of Electronic Science and Technology of China , , ,
Abstract
Background/objectives: Pneumonia frequently precipitates AECOPD, and procalcitonin (PCT) has been utilized to guide antibiotic administration in these patients. However, the specific role and clinical significance of PCT in AECOPD patients who do not have pneumonia remains unexplored and is yet to be thoroughly evaluated.
Methods: We conducted univariate and multivariate cox regression analyses to identify independent risk factors for in-hospital mortality among AECOPD patients. The Youden index was applied to determine the optimal cutoff value for PCT, which was then used to categorize participants into two groups based on this threshold. Subsequently, we compared the clinical manifestations and outcomes of patients between these groups, and Kaplan–Meier curves were con-structed and analyzed using the log-rank test. A subgroup analysis was also conducted in patients with/without antibiotic using during hospitalization.
Results: A total of 6,791 hospitalized AECOPD patients of 10 tertiary care hospitals within China was enrolled in our study from September 2017 to July 2021. Univariable and multivariable cox regression analyses revealed that PCT (HR 1.016, 95% CI 1.003–1.029, p = 0.014) as independent risk factors for in-hospital mortality in AECOPD patients. The ROC analysis established an optimal cut-off value of 0.11 for predicting in-hospital mortality. The PCT high group (≥0.11 ng/mL) demonstrated higher proportion of chronic underlying diseases, and higher age-adjusted Charlson comorbidity index score, increased in-hospital mortality, greater ICU admission rates, higher rates of invasive mechanical ventilation, and a longer length of stay (all P < 0.001). PCT and the cut-off value of 0.11 could also have effective prognostic value in both subgroups of patients with/without antibiotic usage.
Conclusions: PCT emerged as an independent risk factor for in-hospital mortality in AECOPD patients without pneumonia. Those with elevated PCT levels (≥0.11 ng/mL) exhibited a higher burden of comorbidities, a potential of pro-infection or pro-inflammation and poorer clinical outcomes.
Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=12162, identifier ChiCTR2100044625.
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BibTeX
@article{qi2026procalcitonin,
title = {{Procalcitonin as a prognostic factor in patients with acute exacerbation of COPD without pneumonia: a prospective multicenter cohort study}},
author = {Min Qi and Chen Zhou and Yuanming Luo and Hailong Wei and Huiqing Ge and Huiguo Liu and Jianchu Zhang and Xianhua Li and Pinhua Pan and Xiufang Xie and Mengqiu Yi and Lina Cheng and Jiarui Zhang and Lige Peng and Jiaqi Pu and Xueqing Chen and Haixia Zhou and Yongjiang Tang and Qun Yi},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1905875},
url = {https://europepmc.org/article/PMC/PMC13727543},
note = {CC BY},
}
RIS
TY - JOUR
TI - Procalcitonin as a prognostic factor in patients with acute exacerbation of COPD without pneumonia: a prospective multicenter cohort study
AU - Min Qi
AU - Chen Zhou
AU - Yuanming Luo
AU - Hailong Wei
AU - Huiqing Ge
AU - Huiguo Liu
AU - Jianchu Zhang
AU - Xianhua Li
AU - Pinhua Pan
AU - Xiufang Xie
AU - Mengqiu Yi
AU - Lina Cheng
AU - Jiarui Zhang
AU - Lige Peng
AU - Jiaqi Pu
AU - Xueqing Chen
AU - Haixia Zhou
AU - Yongjiang Tang
AU - Qun Yi
PY - 2026
DA - 2026/10/20
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1905875
UR - https://europepmc.org/article/PMC/PMC13727543
AB - Background/objectives: Pneumonia frequently precipitates AECOPD, and procalcitonin (PCT) has been utilized to guide antibiotic administration in these patients. However, the specific role and clinical significance of PCT in AECOPD patients who do not have pneumonia remains unexplored and is yet to be thoroughly evaluated. Methods: We conducted univariate and multivariate cox regression analyses to identify independent risk factors for in-hospital mortality among AECOPD patients. The Youden index was applied to determine the optimal cutoff value for PCT, which was then used to categorize participants into two groups based on this threshold. Subsequently, we compared the clinical manifestations and outcomes of patients between these groups, and Kaplan–Meier curves were con-structed and analyzed using the log-rank test. A subgroup analysis was also conducted in patients with/without antibiotic using during hospitalization. Results: A total of 6,791 hospitalized AECOPD patients of 10 tertiary care hospitals within China was enrolled in our study from September 2017 to July 2021. Univariable and multivariable cox regression analyses revealed that PCT (HR 1.016, 95% CI 1.003–1.029, p = 0.014) as independent risk factors for in-hospital mortality in AECOPD patients. The ROC analysis established an optimal cut-off value of 0.11 for predicting in-hospital mortality. The PCT high group (≥0.11 ng/mL) demonstrated higher proportion of chronic underlying diseases, and higher age-adjusted Charlson comorbidity index score, increased in-hospital mortality, greater ICU admission rates, higher rates of invasive mechanical ventilation, and a longer length of stay (all P < 0.001). PCT and the cut-off value of 0.11 could also have effective prognostic value in both subgroups of patients with/without antibiotic usage. Conclusions: PCT emerged as an independent risk factor for in-hospital mortality in AECOPD patients without pneumonia. Those with elevated PCT levels (≥0.11 ng/mL) exhibited a higher burden of comorbidities, a potential of pro-infection or pro-inflammation and poorer clinical outcomes. Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=12162, identifier ChiCTR2100044625.
SN - 2296-858X
ER -