Impact of hepatic function on serum procalcitonin for the diagnosis of bacterial infections in patients with chronic liver disease: A retrospective analysis of 324 cases.
Impact of hepatic function on serum procalcitonin for the diagnosis of bacterial infections in patients with chronic liver disease: A retrospective analysis of 324 cases.
复制标题
肝功能对慢性肝病患者诊断细菌感染诊断血清促阳性素的影响：324例的回顾性分析。
DOI：
10.1097/md.0000000000004270
复制
发表时间：
2016-07
期刊：
影响因子：
1.6
通讯作者：
Lü X
中科院分区：
文献类型：
--
作者：
Qu J;Feng P;Luo Y;Lü X
虽然降钙素原（PCT）是细菌感染早期诊断的有效标志物，但目前尚不清楚其预测细菌感染的准确性是否受肝功能受损的影响。本研究旨在评估肝功能受损对PCT诊断价值的影响。这项回顾性研究于2013年1月至2015年5月进行。共入组了324例慢性肝病患者。进行常规实验室测量和PCT。根据临床诊断将患者分为3组：慢性肝炎（第1组）、失代偿性肝硬化（第2组）和慢加急性肝衰竭/慢性肝衰竭（第3组）。分析PCT与肝功能的相关性。根据感染状态和肝功能分析PCT的受试者工作特征（AUCROC）曲线下面积。PCT检测肝功能损害患者细菌感染的准确性高于白色细胞计数（P <0.001）和中性粒细胞百分比（P <0.001）。 在无感染的患者中，PCT与血清总胆红素（TBIL）呈中度正相关（r = 0.592），与终末期肝病模型评分（r = 0.483）和国际标准化比值（r = 0.389）呈弱相关。 对于TBIL <5 mg/dL、0.927（95% CI 0.844-0.974）和0.54 ng/mL（5 mg/dL ≤TBIL<10 mg/dL），预测不同TBIL水平下细菌感染的PCT和的AUCROC和最佳阈值分别为0.907（95% CI 0.828-0.958）和0.38 ng/mL，分别为0.914（95% CI 0.820-0.968）和0.61 ng/mL（10 mg/dL ≤TBIL<20 mg/dL）、0.906（95% CI 0.826-0.958）和0.94 ng/mL（TBIL ≥20 mg/dL）。 这项研究表明，PCT是慢性肝病患者细菌感染的有价值的标志物。TBIL影响PCT阈值，应根据不同TBIL值采用不同的临界值。
Supplemental Digital Content is available in the text Although procalcitonin (PCT) is a valid marker for early diagnosis of bacterial infections, it is unclear whether its accuracy in predicting bacterial infections is affected by impaired liver function. This study aimed to assess the impact of compromised liver function on the diagnostic value of PCT. This retrospective study was conducted between January 2013 and May 2015. A total of 324 patients with chronic liver disease were enrolled. Routine laboratory measurements and PCT were performed. Patients were divided into 3 groups according to clinical diagnosis: chronic hepatitis (group 1), decompensated cirrhosis (group 2), and acute-on-chronic liver failure/chronic liver failure (group 3). The correlation between PCT and liver function was analyzed. The area under the receiver operating characteristic (AUCROC) curve of PCT was analyzed according to infection status and liver function. PCT was more accurate than white blood cell count (P < 0.001) and percentage of neutrophils (P < 0.001) in detecting bacterial infections in patients with impaired liver function. In patients without infection, PCT had a moderate positive correlation with serum total bilirubin (TBIL) (r = 0.592), and a weak correlation with model for end-stage liver disease score (r = 0.483) and international normalized ratio (r = 0.389). The AUCROC and optimum thresholds of PCT and for predicting bacterial infections at different levels of TBIL were 0.907 (95% CI 0.828–0.958) and 0.38 ng/mL, respectively, for TBIL <5 mg/dL, 0.927 (95% CI 0.844–0.974) and 0.54 ng/mL (5 mg/dL ≤TBIL<10 mg/dL), 0.914 (95% CI 0.820–0.968) and 0.61 ng/mL (10 mg/dL ≤TBIL<20 mg/dL), 0.906 (95% CI 0.826–0.958) and 0.94 ng/mL (TBIL ≥20 mg/dL), respectively. This study demonstrated that PCT was a valuable marker of bacterial infection in patients with chronic liver diseases. TBIL affected PCT threshold, so different cut-offs should be used according to different TBIL values.