Procalcitonin and C-reactive protein in early diagnosis of sepsis caused by either Gram-negative or Gram-positive bacteria
Procalcitonin and C-reactive protein in early diagnosis of sepsis caused by either Gram-negative or Gram-positive bacteria
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DOI：
10.1007/s11845-016-1457-z
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发表时间：
2017-02-01
影响因子：
2.1
通讯作者：
Su, L.
中科院分区：
文献类型：
--
作者：
Liu, H. H.;Zhang, M. W.;Su, L.
脓毒症是全身性炎症反应综合征（SIRS）最常见的病因。降钙素原（PCT）和c反应蛋白（CRP）是众所周知的脓毒症的预测因子。脓毒症患者血清PCT水平与血培养阳性相关，但在革兰氏阴性（GN）菌血症和革兰氏阳性（GP）菌血症中，脓毒症发病时PCT和CRP水平升高的幅度尚不清楚。目的评价GN型和GP型菌血症患者发生脓毒症72 h内的PCT和CRP水平。方法回顾性分析厦门市三所综合教学医院648例血阳性标本的资料。147名72小时内脓毒症的成年患者参加了这项研究。根据GN或GP菌血症评估血清PCT和CRP水平。结果147例（22.68%）患者符合纳入研究条件，其中GP败血症56例，GN败血症91例。GP组患者的PCT水平显著高于GN组（23.64 vs 6.18 ng/mL, p < 0.001），但CRP水平未见显著升高。PCT的受试者工作特征（ROC）曲线下面积为0.73(95%可信区间为0.65 ~ 0.81)，CRP的受试者工作特征（ROC）曲线下面积为0.52（95%可信区间为0.43 ~ 0.62）。阳性预测值为72.5%，阴性预测值为67.9%，PCT临界值为2.1 ng/ml。结论GN型脓毒症72h血清PCT水平高于GP型脓毒症，CRP水平差异无统计学意义。PCT与CRP分离现象有助于GP败血症的早期诊断。
Background Sepsis is the most frequent cause of systemic inflammatory response syndrome (SIRS). Procalcitonin (PCT) and C-reactive protein (CRP) are well-known predictors of sepsis. Serum PCT levels are associated with blood culture positivity in patients with sepsis, but the magnitude of elevation of PCT and CRP levels at the onset of sepsis is unknown in Gram-negative (GN) bacteremia and in Gram-positive (GP) bacteremia.Aims To evaluate the PCT and CRP levels in 72 h at the onset of sepsis in GN and GP bacteremia. Methods We retrospectively analyzed the data from 648 blood-positive specimens from three integrated teaching hospitals in Xiamen, China. One hundred and forty-seven adult patients with sepsis within 72 h enrolled in the study. Serum PCT and CRP level were assessed according GN or GP bacteremia.Results A total of 147 (22.68 %) patients were eligible for inclusion in the study, including 56 GP sepsis and 91 GN sepsis. PCT, but not CRP levels, was significantly higher in patients in the GP group than in the GN group (23.64 vs 6.18 ng/mL, p < 0.001). The area under the receiver-operating characteristic (ROC) curve of PCT was 0.73 (95 % confidence interval 0.65-0.81) and that under the ROC curve of CRP was 0.52 (95 % confidence interval 0.43-0.62). A positive predictive value of 72.5 % and a negative predictive value of 67.9 % were achieved with a PCT cutoff value of 2.1 ng/ml.Conclusion Serum PCT levels are higher in GN sepsis than GP sepsis in 72 h. There are not differences in CRP. The separation of PCT and CRP phenomenon is helpful for early diagnosis of GP sepsis.