Serum Procalcitonin in Patients with Acute Liver Failure.
Serum Procalcitonin in Patients with Acute Liver Failure.
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发表时间：
2017-03
影响因子：
1
通讯作者：
T. Sugihara;M. Koda;T. Okamoto;Kenichi Miyoshi;T. Matono;K. Oyama;K. Hosho;J. Okano;H. Isomoto
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作者：
T. Sugihara;M. Koda;T. Okamoto;Kenichi Miyoshi;T. Matono;K. Oyama;K. Hosho;J. Okano;H. Isomoto
背景降钙素原（PCT）是已知的细菌感染的诊断标志物。既往没有关于急性肝衰竭（ALF）的PCT报告。我们评估了血清PCT水平在ALF患者中的临床价值。方法回顾性纳入2001年1月至2015年6月的44例急性肝炎患者（男性19例，女性25例;中位年龄40岁;范围20-79岁）。PCT水平通过在入院后3天内获得的保存的血清样本来测量。ALF定义为凝血酶原时间（PT）< 40%，与肝性脑病无关。结果16例ALF患者血清PCT水平显著高于28例非ALF患者[0.25（0.13-2.66）ng/mL vs.0.165（0.03-1.08）ng/mL，P = 0.00967]。肌酐、总胆红素和直接胆红素呈正相关，PT与PCT呈负相关。受试者工作特征曲线分析显示检测ALF的曲线下面积为0.74。当PCT临界值为0.5 ng/mL时，ALF的存在可被证明具有低灵敏度（37.5%）和高特异性（96.5%），以及高阳性（85.7%）和阴性（72.9%）预测值。多因素分析显示PCT是与ALF相关的独立因素。PCT ≥ 0.5 ng/mL患者的累积生存率也显著降低（P = 0.0314），但不是独立的预后因素。结论ALF患者血清PCT水平明显升高。
BACKGROUND Procalcitonin (PCT) is a known diagnostic marker of bacterial infection. There are no previous reports of PCT concerning acute liver failure (ALF). We evaluated the clinical value of serum PCT levels in patients with ALF. METHODS Forty-four patients with acute hepatitis (19 men and 25 women; median age, 40 years; range, 20-79 years) were retrospectively enrolled from January 2001 and June 2015. PCT levels were measured by saved serum samples obtained within 3 days after admission. ALF was defined as prothrombin time (PT) < 40% regardless of hepatic encephalopathy. RESULTS Serum PCT levels were significantly higher in the patients with ALF (n = 16) than in those with non-ALF (n = 28) [0.25 (0.13-2.66) ng/mL vs. 0.165 (0.03-1.08), P = 0.00967]. Creatinine, total bilirubin, and direct bilirubin were positively correlated, and PT was negatively correlated with PCT. Receiver operating characteristic curve analysis showed an area under the curve of 0.74 for detecting ALF. With a PCT cut-off value of 0.5 ng/mL, the presence of ALF could be demonstrated with low sensitivity (37.5%) and high specificity (96.5%) with high positive (85.7%) and negative (72.9%) predictive value. Multivariate analysis showed that PCT was an independent factor associated with the presence of ALF. The cumulative survival rate was also significantly lower in patients with PCT ≥ 0.5 ng/mL (P = 0.0314), but it was not an independent prognostic factor. CONCLUSION Serum PCT level was significantly higher in patients with ALF.