Comparison of procalcitonin, C-reactive protein and neutrophil/lymphocyte ratio in prediction of noninvasive mechanical ventilation failure in patients admitted to the emergency department with COPD exacerbation

ÇATAL H. S., DOĞAN N. Ö., ÖZTURAN İ. U., PEKDEMİR M., YAKA E., YILMAZ S.

American Journal of Emergency Medicine, cilt.100, ss.12-17, 2026 (SCI-Expanded, Scopus) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 100
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1016/j.ajem.2025.11.009
  • Dergi Adı: American Journal of Emergency Medicine
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
  • Sayfa Sayıları: ss.12-17
  • Anahtar Kelimeler: C-reactive protein, Chronic obstructive pulmonary disease, Emergency department (MeSH database), Exacerbation, Noninvasive ventilation, Procalcitonin
  • Kocaeli Üniversitesi Adresli: Evet

Özet

Background: Non-invasive mechanical ventilation (NIMV) represents a cornerstone therapy for acute chronic obstructive pulmonary disease (COPD) exacerbation in emergency department (ED) settings. Objectives: Clinical predictors of NIMV response remain poorly characterized. This study sought to evaluate and compare the predictive capacity of different biomarkers for identifying patients at risk of NIMV failure during acute exacerbations. Methods: This prospective cohort study was conducted in the ED of a tertiary center from March 2023 to December 2024. Consecutive patients presenting with acute COPD exacerbations and meeting criteria for NIMV were enrolled. The primary outcome (NIMV failure) was evaluated during the initial 2-h monitoring period. The predictive performance of C-reactive protein (CRP) and procalcitonin levels, and neutrophil-to-lymphocyte ratio (NLR) were assessed using receiver operating characteristic (ROC) curve analysis. Areas under the curve (AUC) were compared using the de-Long method. Results: Among 151 enrolled patients, 73 (48.3 %) experienced NIMV failure, with an associated mortality rate of 30.1 %. For NIMV failure, ROC analysis demonstrated superior predictive performance for NLR (AUC = 0.804, 95 % confidence interval [CI]:0.734–0.875) compared to CRP (AUC = 0.680, 95 % CI:0.594–0.765) and procalcitonin (AUC = 0.682, 95 % CI:0.596–0.767). ROC analysis identified an optimal NLR cutoff of 5.8 for predicting NIMV failure, demonstrating 79.5 % sensitivity and 70.5 % specificity. When integrated with the HACOR score, this NLR threshold showed enhanced specificity with reduced sensitivity. Conclusion: The present study demonstrated that NLR was the strongest predictor of NIMV failure in the ED compared to CRP or procalcitonin. The combination of biomarkers with the HACOR score significantly enhanced prognostic accuracy.