Hubungan antara kadar procalcitonin dengan kriteria Anthonisen pada PPOK eksaserbasi akut


  • Ariska Megasari Universitas Udayana
  • Ida Bagus Ngurah Rai
  • Ketut Suryana



procalcitonin (PCT), Anthonisen criteria, acute exacerbation COPD


Background: COPD exacerbations can be caused by infections and environmental pollutants. One guideline for antibiotic administration in acute exacerbation COPD  is in patients with Anthonisen criteria types 1 and 2 based on patients' subjective complaints (increased dyspneu, increased sputum volume and sputum purulence). Procalcitonin (PCT) is an objective and specific marker of bacterial infections that are not affected much by  disease condition or steroid drugs that are widely used by COPD patients. This study was conducted to determine the relationship between procalcitonin levels and Anthonisen criteria in acute exacerbation of COPD.

Methods: This study used an analytical cross sectional design at Sanglah General Hospital and Wangaya Hospital in March-May 2018. Data analysis used the Bivariate Spearman correlation test, and Kruskal-wallis to determine the median PCT level difference according to Anthonisen type.

Result: Total subjects were 43 samples of acute exacerbation COPD patients, with median PCT levels were 0.18 (0.02-47.8) ng/ml. Spearman correlation analysis showed no significant correlation between serum PCT levels and Anthonisen type (r = -0,175, p = 0.26). We also found a significant correlation between Anthonisen criteria with WBC and neutrophil count. After excluding several outliers data, there was a significant difference in median PCT value based on the Anthonisen type. The median PCT was higher in Anthonisen type 1 compared to type 2 and 3 (p = 0.029). 

Conclusion: there was no relationship between levels of PCT with Anthonisen type but we found significant higher PCT level in Anthonisen type 1 after excluding extreme value.


Download data is not yet available.


1. Robbins RA. COPD exacerbation: an evidence-based review. Southwest J Pulm Crit Care. 2012;5:36-51
2. Decramer M, Agusti AG, Bourbeau J, dkk. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease update 2016. Global Initiative for Chronic Obstructive Pulmonary Disease Inc [serial online] 2016 [diakses 20 Juni 2016]. Diunduh dari:
3. Halpin DM, Decramer M, Celli B, dkk. Exacerbation frequency and course of COPD. Int J Chron Obstruct Pulmon Dis. 2012; 7:653-61
4. Soler N, Agusti C, Angrill, J, dkk. Bronchoscopic validation of the significance of sputum purulence in severe exacerbation of chronic obstructive pulmonary disease. Thorax. 2007;62:29-35
5. Schuetz P, Albrich, W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011;9(107):1-9
6. Foushee JA, Hope N, Grace EE. Applying biomarkers to clinical practice: a guide for utilizing procalcitonin assays. J Antimicrob Chemother. 2012; 67(11):2560-2569
7. Li H, Luo YF, Blackwell TS, dkk. Meta analysis and systematic review of procalcitonin-guided therapy in respiratory tract infections. Antimicrob Agents Chemoter. 2011; 55(12):5900-5906
8. Laue J, Reierth E, Melbye H. When should acute exacerbations of COPD be treated with systemic corticosteroids and antibiotics in primary care: a systemic review of current COPD guidelines. NPJ Rim Care Respir Med. 2015; 25:1-6
9. Stolz D, Christ-crain M, Morgenthaler NG, dkk. Copeptin, C-reactive protein, and procalcitonin as a prognostic biomarkers in acute exacerbation of COPD. Chest. 2007; 131:1058-1067
10. Sethi S. Bacteria in exacerbations of chronic obstructive pulmonary disease, phenomenon or epiphenomenon. Proc Am Thorax Soc. 2004; 1(2):109-114
11. Christ-crain M, Stolz DJ, Bingisser R, dkk. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004; 363:600-07
12. Burke L, Alhajji M, Todd N, dkk. Procalcitonin (PCT) is a safe and reliable biomarker of bacterial infection in exacerbation of COPD-so why is it so challenging to introduce it into a large UK hospital?. Thorax. 2010; 65:A125-A126
13. Beasley V, Joshi PV, Singanayagam A, dkk. Lung microbiology and exacerbation in COPD. Int J Chron Obstruct Pulmon Dis. 2012; 7:555-569
14. Valk PV, Monninkhof E, Palen JV, dkk. Clinical predictors of bacterial involvement in exacerbations of chronic obstructive pulmonary disease. Clin Infect Dis. 2004; 39:980-6
15. Lacoma, A, Prat C, Andreo F, dkk. Biomarkers in the management of COPD. Eur Respir Rev. 2009; 18(112):96-104.
16. Falsey AR, Becker KL, Swinburne AJ, dkk. Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note. Int J Chron Obstruct Pulmon Dis. 2012; 7:127-135
17. Pazarli AC, Koseoglu HI, Doruk S, dkk. Procalcitonin: is it a predictor of noninvasive positive pressure ventilation necessity in acute chronic obstructive pulmonary disease exacerbation?. J Res Med Sci. 2012;17(11):1047-1051
18. Chaudhury A, Sumant GLS, Jayaprada R, dkk. Procalcitonin in sepsis and bacterial infections. J Clin Sci Res. 2013;2:216-24
19. Chmielewski PP, Strzelec B. Elevated leukocyte count as a harbinger of systemic inflammation, disease progression, and poor prognosis: a review. Folia Morphol. 2017




How to Cite

Megasari A, Rai IBN, Suryana K. Hubungan antara kadar procalcitonin dengan kriteria Anthonisen pada PPOK eksaserbasi akut. Udayana In. Med. [Internet]. 2019 Feb. 15 [cited 2023 Sep. 24];3(1):8-13. Available from: