Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock
Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock
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DOI：
10.1007/bf02900728
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发表时间：
2000-01-01
影响因子：
38.9
通讯作者：
Brunkhorst, R
中科院分区：
文献类型：
--
作者：
Brunkhorst, FM;Wegscheider, K;Brunkhorst, R
目的：探讨降钙素原（PCT）在SIRS、脓毒症、严重脓毒症、脓毒症休克患者早期诊断和鉴别中的价值，并与c反应蛋白（CRP）、白细胞和血小板计数、APACHE-II评分（AP-II）进行比较。设计：前瞻性队列研究，纳入所有连续7个月疑似感染入住ICU的患者。患者和方法：共纳入185例患者：SIPS 17例，脓毒症61例，严重脓毒症68例，脓毒症休克39例。结果：感染性休克患者的CPP、细胞计数、AS-II和PCT值最高（12.89 +/- 4.39 ng/ml，与严重脓毒症患者相比P < 0.05）。严重脓毒症患者的PCT水平明显高于脓毒症或SIPS患者（分别为6.91 +/- 3.87 ng/ml vs 0.53 +/- 2.9 ng/ml, P < 0.001和0.41 +/- 3.04 ng/ml, P < 0.001）。脓毒症、严重脓毒症和SIRS患者AP-IT评分差异无统计学意义（分别为19.26 +/- 1.62、16.09 +/- 2.06和17.42 +/- 1.72分），但脓毒症休克患者AP-IT评分明显高于严重脓毒症患者（29.27 +/- 1.35,P < 0.001）。脓毒症与严重脓毒症之间CRP、细胞计数、发热程度均无显著性差异，而严重脓毒症与感染性休克之间白细胞计数、血小板计数均有显著性差异。结论：与AP-II相比，PCT似乎是区分脓毒症和严重脓毒症的有用早期标志物。
Objective:To determine the value of procalcitonin (PCT) in the early diagnosis land differentiation) of patients with SIRS, sepsis, severe sepsis, and septic shock in comparison to C-reactive protein (CRP), white blood cell and thrombocyte count, and APACHE-II score (AP-II).Design: Prospective cohort study including all consecutive patients admitted to the ICU with the suspected diagnosis of infection over a 7-month period.Patients and methods: A total of 185 patients were included: 17 patients with SIPS, 61 with sepsis, 68 with severe sepsis, and 39 patients with septic shock. CPP, cell counts, AS-II and PCT were evaluated on the first day after onset of inflammatory symptoms,Results: PCT values were highest in patients with septic shock (12.89 +/- 4.39 ng/ml; P < 0.05 vs patients with severe sepsis). Patients with severe sepsis had significantly higher PCT levels than patients with sepsis or SIPS (6.91 +/- 3.87 ng/ml vs 0.53 +/- 2.9 ng/ml; P < 0.001, and 0.41 +/- 3.04 ng/ml; P < 0.001, respectively). AP-IT scores did not differ significantly between sepsis, severe sepsis and SIRS (19.26 +/- 1.62, 16.09 +/- 2.06, and 17.42 +/- 1.72 points, respectively), but was significantly higher in patients with septic shock (29.27 +/- 1.35, P < 0.001 vs patients with severe sepsis). Neither CRP, cell counts, nor the degree of fever showed significant differences between sepsis and severe sepsis, whereas white blood cell count and platelet count differed significantly between severe sepsis and septic shock.Conclusions: In contrast to AP-II, PCT appears to be a useful early marker to discriminate between sepsis and severe sepsis.