# Association of Procalcitonin, C-reactive Protein, and White Blood Cell Count With Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

## TL;DR

This study shows that higher levels of PCT, CRP, and WBC are linked to more severe COPD, especially in patients with acute exacerbations.

## Contribution

The study provides evidence that PCT, CRP, and WBC can help assess COPD severity and exacerbation status in clinical practice.

## Key findings

- Category E patients had significantly higher PCT, CRP, and WBC levels compared to category B patients.
- Inflammatory marker levels did not vary significantly across mMRC dyspnea grades.
- Elevated biomarkers were associated with more severe COPD and acute exacerbations.

## Abstract

Background

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are characterized by heightened airway and systemic inflammation. Inflammatory biomarkers such as white blood cell (WBC) count, procalcitonin (PCT), and C-reactive protein (CRP) may serve as useful indicators of the presence of acute exacerbations and assist in clinical assessment and management. The present study aimed to evaluate variations in these inflammatory markers in relation to the clinical status of patients during AECOPD.

Methods

A cross-sectional study was conducted in the Department of Biochemistry and Respiratory Medicine at Sawai Man Singh Hospital, Jaipur, India, and included 80 spirometry-confirmed COPD patients diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 guidelines. Categories B and E patients, as per GOLD 2023 guidelines, were included for a direct comparison of acute exacerbation. Demographic characteristics, comorbidities, GOLD classification, Modified Medical Research Council dyspnea grade (mMRC), and smoking history were recorded. Levels of PCT, CRP, and WBC count were compared across Categories B and E and dyspnea grades.

Results

The cohort of 80 patients had a mean age of 65.7 years with a standard deviation of 12.2 years. There were 66 (82.5%) males and 14 (17.5%) females. Hypertension and diabetes were the most common comorbidities. Based on GOLD criteria, 50 (62.5%) were classified as category E and 30 (37.5%) as category B. Category E patients had significantly higher levels of PCT, CRP, and WBC compared to category B. Most patients belonged to mMRC grades 2 and 3; however, inflammatory marker levels did not differ significantly across mMRC grades.

Conclusion

PCT, CRP, and WBC levels were significantly elevated in patients with more severe COPD, particularly those in GOLD category E, indicating their usefulness in assessing disease severity and inflammatory burden. Incorporating these biomarkers may enhance the evaluation of COPD exacerbation severity and guide management strategies in COPD.