الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that affects small airways, lung parenchyma, and vascular endothelium.
COPD is not a disease that affects only the lungs; it is a systemic inflammatory and endothelial disease, It is characterized by airflow limitation, breathlessness and exacerbations
Exacerbations are important events with a significant influence on prognosis, and prevention of exacerbations is a central element in the management of COPD.
The aim of this study was to assess levels of procalcitonin and sTREM -1in COPD and evaluate the role of them in diagnosis of AECOPD with bacterial infections .
The present study was carried out at the Clinical Pathology Department, chest department, Faculty of Medicine, Minia University, Minia, Egypt through the period from May 2020 to April 2021. It was conducted on 60 subjects after ethical committee approval and a written consent was obtained from each patient.
I. Subjects:
The subjects included in the study were divided as follows:
group I (Exacerbation group):
It included Twenty (20) patients suffering from COPD on exacerbation. Patients were selected from in-patient wards of Chest Department of Minia University Hospital.
group II (Stable COPD group):
It included Twenty (20) patients have stable COPD. The patients were selected from out-patient clinic of Chest Department of Minia University Hospital.
group III (control group):
It included 20 apparently healthy individuals. All the control participants were matched with patient groups in terms of age.
Exclusion criteria
• Recent antibiotic intake
• Evidence of pneumonia by x-ray or other bacterial infection else.
All subjects included in the study were subjected to the following:
1) Careful history taking:
Considering age, occupation, residence, duration of disease, smoking status, presence of cough, expectoration, fever, dyspnea and co-morbidities.
2) Examinations: Complete general, abdominal and local examinations.
3)Laboratory Investigations:
(A) Routine investigations: Included complete blood count (CBC), erythrocyte sedimentation rate (ESR), renal function tests, C-reactive protein (CRP) and sputum culture.
(B) Special investigations: Included assessment of sTREM-1 and procalcitonin.
The results of this study were summarized as follow:
• There was no significant difference between the three groups regarding age , sex
• There was significant difference between group I and II regarding dyspnea and fever
• Regarding Hb, TLC, Platelets and renal function there was no statistically significant difference between the studied groups
• Procalcitonin , sTREM-1, neutrophils, eosinophil and monocytes and NL ratio were higher in group I compared to group II and III
• In group I (AECOPD )the result of sputum cultures revealed ; 65 % gram negative bacteria and (35% ) gram positive bacteria while in group II (stable COPD ) the results showed that growth of normal upper respiratory tract flora in (65%) then gram positive bacteria (20 %) then gram negative bacteria (15 %).
• Pseudomonas is the commonest causative organism of EACOPD (35 %) followed by staph aureus (25%) then E coli , klebsiella , enterococcus and enterobacter 10 % for each. while in group II (stable COPD), growth of upper respiratory tract normal flora was the predominant (65 %) then staph aureus and enterococcus 10 % for each
• Procalcitonin , sTREM -1and NLR showed a higher level in patients who had gram negative infection than those with gram positive infection and the lowest level was in those showed growth of normal flora
• There was significant positive correlation between sTREM-1 on one hand and neutrophils, NL ratio, CRP and procalcitonin on the other hand
• There was significant positive correlation between procalcitonin on one hand and neutrophils, NL ratio, CRP and sTREM-1 on the other hand
Conclusions
Overall, the findings of this study indicate that sTREM-1 and PCT levels can be regarded as an appropriate diagnostic marker in patients with exacerbated COPD due to bacterial infection and in differentiating them from patients with stable conditions.
NLR showed highest level in AECOPD than stable COPD and healthy control.