A Trial of Procalcitonin in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Procalcitonin-guided Initiation of Antibiotics in AECOPD Inpatients: a Multicenter Randomized Controlled Trial

Current antibiotic prescription for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is generally based on the Anthonisen criteria in The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guideline, that has a potential risk of antibiotics overuse. The dilemma is to identify patients who are most likely to benefit from antibiotics while avoiding unnecessary antibiotic use. Procalcitonin (PCT), a more sensitive and specific biomarker of bacterial infection than other conventional laboratory tests, has the potential to determine those patients in whom antibiotics would be beneficial. It is unclear whether PCT-guided antibiotic therapy is safe and effective for inpatients with AECOPD. The investigators aim to conduct a 2-arm, multicenter randomized controlled trial in China to determine whether PCT-guided antibiotic therapy will reduce the antibiotic prescription rate for AECOPD without negatively impacting the treatment success rate, compared with the GOLD guideline antibiotic recommendations.

This trial will recruit 500 hopitalized patients with AECOPD. The eligible participants will be randomly assigned to either PCT group or guideline group.The investigators aim to compare the efficacy and safety between PCT-gudied antibiotic therapy and guideline-guided antibiotic recommendations. The primary hypothesis is that PCT-guided antibiotic therapy will reduce the antibiotic prescription rate for AECOPD without negatively impacting the treatment success rate, compared with the GOLD guideline antibiotic recommendations.

Inclusion Criteria:

• Hospitalized patients with AECOPD
• ≥40 years of age
• Able to understand and communicate to ensure the completion of the trial
• Voluntary participation and provide written informed consent

Exclusion Criteria:

• Fever, Axillary temperature≥38°C
• Pneumonia identified by X-Ray or CT of the chest
• Severe respiratory failure requiring admittance to ICU
• Concurrent infection at another site (e.g. urinary tract infection)
• Immunosuppression secondary to chemotherapy, AIDS or malignant tumor of blood system
• Comorbidities requiring corticosteroids (prednisone 30mg/d or equivalent more than 30 days )
• Invasive mechanical ventilation
• Patients with malignant tumors receiving chemotherapy or radiotherapy
• Pregnancy
• Participation in another clinical trial
• Previously enrollment into the study
• Refuse to attend