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Procalcitonin as a prognostic factor in patients with acute exacerbation of COPD without pneumonia: a prospective multicenter cohort study

Year: 2026
Type: article
Study design: Observational Study
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.
DOI: 10.3389/fmed.2026.1905875
Authors: Min Qi, Chen Zhou, Yuanming Luo, Hailong Wei, Huiqing Ge, Huiguo Liu, Jianchu Zhang, Xianhua Li, Pinhua Pan, Xiufang Xie, Mengqiu Yi, Lina Cheng, Jiarui Zhang, Lige Peng, Jiaqi Pu, Xueqing Chen, Haixia Zhou, Yongjiang Tang, Qun Yi
Institutions: University of Electronic Science and Technology of China, Sichuan University, West China Medical Center of Sichuan University, West China Hospital of Sichuan University, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, State Key Laboratory of Biotherapy, State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Sir Run Run Shaw Hospital, Zhejiang University, Tongji Hospital, Huazhong University of Science and Technology, The First People's Hospital of Neijiang, Central South University, Xiangya Hospital Central South University, Jiujiang First People's Hospital, Sichuan Cancer Hospital
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223012834
FWCI:
Cites: 35
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Related to: 10