Marc Miravitlles1, Ana Moragas2, Silvia Hernández2, Carolina Bayona3, Carl Llor2. 1. Servei de Pneumologia, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona. Electronic address: marcm@separ.es. 2. Primary Care Centre Jaume I, University Rovira i Virgili, Tarragona. 3. Primary Care Centre Valls, Tarragona, Spain.
Abstract
BACKGROUND: Anthonisen criteria are widely used to guide the use of antibiotics in exacerbations of COPD. We evaluated the best predictors of outcomes in exacerbations of mild to moderate COPD not treated with antibiotics. METHODS: We used data from 152 patients of theplacebo arm of a randomized trial of amoxicillin/clavulanatefor exacerbations of mild to moderate COPD. Clinical response in relation to Anthonisen criteria and point-of-care serum C-reactive protein (CRP) tests (cutoff, 40 mg/L) was assessed with multivariate logistic regression analysis. RESULTS:Clinical failure without antibiotics was 19.9% compared with 9.5% with amoxicillin/clavulanate (P = .022). The only factors significantly associated with an increased risk of failure without antibiotics were the increase in sputum purulence (OR, 6.1; 95% CI, 1.5-25.0; P = .005) and a CRP concentration ≥ 40 mg/L (OR, 13.4; 95% CI, 4.6-38.8; P < .001). When both factors were present, the probability of failure without antibiotics was 63.7%. The Anthonisen criteria showed an area under the curve of 0.708 (95% CI, 0.616-0.801) for predicting clinical outcome. With the addition of CRP level, the area under the curve rose significantly to 0.842 (95% CI, 0.76-0.924; P < .001). CONCLUSIONS: Among the Anthonisen criteria, only an increase in sputum purulence is a significant predictor of failure without antibiotics. The use of a point-of-care CRP test significantly increases the predictive accuracy of failure. Both of these easy-to-obtain factors may help clinicians to identify patients with exacerbated mild to moderate COPD who can be safely treated without antibiotics in an ambulatory setting. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00495586; URL: www.clinicaltrials.gov.
RCT Entities:
BACKGROUND:Anthonisen criteria are widely used to guide the use of antibiotics in exacerbations of COPD. We evaluated the best predictors of outcomes in exacerbations of mild to moderate COPD not treated with antibiotics. METHODS: We used data from 152 patients of the placebo arm of a randomized trial of amoxicillin/clavulanate for exacerbations of mild to moderate COPD. Clinical response in relation to Anthonisen criteria and point-of-care serum C-reactive protein (CRP) tests (cutoff, 40 mg/L) was assessed with multivariate logistic regression analysis. RESULTS: Clinical failure without antibiotics was 19.9% compared with 9.5% with amoxicillin/clavulanate (P = .022). The only factors significantly associated with an increased risk of failure without antibiotics were the increase in sputum purulence (OR, 6.1; 95% CI, 1.5-25.0; P = .005) and a CRP concentration ≥ 40 mg/L (OR, 13.4; 95% CI, 4.6-38.8; P &lt; .001). When both factors were present, the probability of failure without antibiotics was 63.7%. The Anthonisen criteria showed an area under the curve of 0.708 (95% CI, 0.616-0.801) for predicting clinical outcome. With the addition of CRP level, the area under the curve rose significantly to 0.842 (95% CI, 0.76-0.924; P &lt; .001). CONCLUSIONS: Among the Anthonisen criteria, only an increase in sputum purulence is a significant predictor of failure without antibiotics. The use of a point-of-care CRP test significantly increases the predictive accuracy of failure. Both of these easy-to-obtain factors may help clinicians to identify patients with exacerbated mild to moderate COPD who can be safely treated without antibiotics in an ambulatory setting. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00495586; URL: www.clinicaltrials.gov.
Authors: David Gillespie; Christopher C Butler; Janine Bates; Kerenza Hood; Hasse Melbye; Rhiannon Phillips; Helen Stanton; Mohammed Fasihul Alam; Jochen Wl Cals; Ann Cochrane; Nigel Kirby; Carl Llor; Rachel Lowe; Gurudutt Naik; Evgenia Riga; Bernadette Sewell; Emma Thomas-Jones; Patrick White; Nick A Francis Journal: Br J Gen Pract Date: 2021-03-26 Impact factor: 5.386
Authors: Nick A Francis; David Gillespie; Patrick White; Janine Bates; Rachel Lowe; Bernadette Sewell; Rhiannon Phillips; Helen Stanton; Nigel Kirby; Mandy Wootton; Emma Thomas-Jones; Kerenza Hood; Carl Llor; Jochen Cals; Hasse Melbye; Gurudutt Naik; Micaela Gal; Deborah Fitzsimmons; Mohammed Fasihul Alam; Evgenia Riga; Ann Cochrane; Christopher C Butler Journal: Health Technol Assess Date: 2020-03 Impact factor: 4.014