Inflammatory Markers in Patients Using Domiciliary Non-invasive Mechanical Ventilation: C Reactive Protein, Procalcitonin, Neutrophil Lymphocyte Ratio.

Birsen Ocakli,Nalan Adiguzel,Emine Aksoy,Huriye Berk Takir,Sinem Gungor,Eylem Tuncay,Ilim Irmak,Ozlem Yazicioglu Mocin,Nezihe Ciftaslan Goksenoglu,Zuhal Karakurt,Meltem Sertbas

doi:10.3389/fpubh.2018.00245

Abstract

Aim: Early identification and treatment of infections in patients using domiciliary non-invasive mechanical ventilation (NIMV) due to chronic respiratory failure (CRF) can reduce hospital admissions. We assessed C-reactive protein (CRP), procalcitonin, and neutrophil lymphocyte ratio (NLR) as indicators of infection/inflammation.Methods: The study was designed as a retrospective, observational, cross-sectional study, and was performed in 2016 in an intensive care unit outpatient clinic in patients using NIMV. Patients who came to the outpatient clinic with dyspnea, increased sputum, increased prothrombin, and who had hemogram, procalcitonin, and serum CRP, NLR, and PLT/MPV levels assessed, were enrolled into the study. Demographic characteristics, co-morbid diseases, respiratory symptoms, hemogram, biochemistry, CRP, and procalcitonin values in stable and acute attack patients were recorded from patient files. The descriptive statistics and CRP, NLR, and procalcitonin values were assessed.Results: During the study period, 49 patients (24 female) with chronic obstructive pulmonary disease (COPD, n = 24), obesity hypoventilation syndrome (OHS, n = 15), or interstitial lung disease, n = 10), and having had three inflammatory markers assessed, were included in the study. Their mean age was 67 (SD ± 12). Stable patients vs. those who had an acute attack was 41 vs. eight, and within 7 days of outpatient admission four patients were hospitalized. CRP, NLR, and PLT/MPV values were similar in patients' who had sputum purulence, and an increase in dyspnea and sputum, but procalcitonin was significantly higher in patients who had an acute attack. Procalcitonin was not correlated with CRP, NLR, and PLT/MPV.Conclusions: Patients with CRF had similar levels of CRP and NLR during a stable and acute attack state. Procalcitonin may be a better marker for therapeutic decisions in advanced chronic inflammatory diseases.

Highlights

Long-term oxygen therapy and non-invasive mechanical ventilation (NIMV) are the most appropriate adjunctive treatment options when the underlying disease does not improve despite optimal medical treatment in chronic hypercapnic and hypoxemic respiratory failure [1]
Procalcitonin levels were significantly higher in patients in the acute state (p = 0.001) (Table 2)
neutrophil/lymphocyte ratio (NLR), platelet to mean platelet volume (PLT/mean platelet volume (MPV)), and C reactive protein (CRP) levels were similar in both groups

Summary

Introduction

Long-term oxygen therapy and non-invasive mechanical ventilation (NIMV) are the most appropriate adjunctive treatment options when the underlying disease does not improve despite optimal medical treatment in chronic hypercapnic and hypoxemic respiratory failure [1]. The majority of these patients have advanced obstructive and restrictive respiratory function. Differentiation of the etiology of respiratory deterioration is crucial for preventing morbidity and mortality in these patients with chronic respiratory failure. Diagnosis and treatment of respiratory infections in patients with chronic respiratory failure is crucial for control of the disease in response to treatment. Increased leukocytes and increased inflammatory markers support the diagnosis of infection

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