Procalcitonin Levels Predict Bacteremia in Patients With Community-Acquired Pneumonia A Prospective Cohort Trial
Procalcitonin Levels Predict Bacteremia in Patients With Community-Acquired Pneumonia A Prospective Cohort Trial
复制标题
DOI：
10.1378/chest.09-2920
复制
发表时间：
2010-07-10
期刊：
影响因子：
9.6
通讯作者：
Schuetz, Philipp
中科院分区：
文献类型：
--
作者：
Mueller, Fabian;Christ-Crain, Mirjam;Schuetz, Philipp
背景：指南建议对疑似社区获得性肺炎(CAP)住院患者进行血液培养采样。然而，真阳性结果的得率很低。我们调查了入院时应用降钙素原(PCT)来预测CAP患者血培养阳性的益处。方法：这是一项前瞻性队列研究，包括925名CAP患者入院时进行血培养采样。结果：共有73名患者(7.9%)患有真正的菌血症(463名患者中43人，验证队列中462人中30人)。PCT的受试者工作特性曲线下面积在派生和验证队列中相似(派生队列，0.83；95%可信区间，0.78-0.89；验证队列，0.79；95%可信区间，0.72-0.88)。总体而言，与白细胞计数、C反应蛋白和其他临床参数相比，PCT是血培养阳性的明显更好的预测因子。在多元回归分析中，只有抗生素治疗(调整后的优势比，0.25；P<；0.05)和PCT血清水平(调整后的优势比，3.72；P<；.001)是独立的预测因素。总体而言，PCT的临界值为0.1ug/L可使血培养总数减少12.6%，同时仍可识别99%的阳性血培养。同样，以0.25mg/L和0.5mg/L为临界值可使血培养分别减少37%和52%，仍可分别识别96%和88%的血培养阳性。结论：初始PCT水平准确预测慢性阻塞性肺疾病患者血培养阳性。PCT测量有可能减少急诊科抽血培养的数量，并对有限的卫生保健资源进行更有针对性的分配。
Background: Guidelines recommend blood culture sampling from hospitalized patients with suspected community-acquired pneumonia (CAP). However, the yield of true-positive results is low. We investigated the benefit of procalcitonin (PCT) on hospital admission to predict blood culture positivity in CAP.Methods: This was a prospective cohort study with a derivation and validation set including 925 patients with CAP who underwent blood culture sampling on hospital admission.Results: A total of 73 (7.9%) patients had true bacteremia (43 of 463 in the derivation cohort, 30 of 462 in the validation cohort). The area under the receiver operating characteristics curve of PCT in the derivation and validation cohorts was similar (derivation cohort, 0.83; 95% CI, 0.78-0.89; validation cohort, 0.79; 95% CI, 0.72-0.88). Overall, PCT was a significantly better predictor for blood culture positivity than WBC count, C-reactive protein, and other clinical parameters. In multivariate regression analysis, only antibiotic pretreatment (adjusted odds ratio, 0.25; P < .05) and PCT serum levels (adjusted odds ratio, 3.72; P < .001) were independent predictors. Overall, a PCT cutoff of 0.1 mu g/L would enable reduction of the total number of blood cultures by 12.6% and still identify 99% of the positive blood cultures. Similarly, 0.25 mu g/L and 0.5 mu g/L cutoffs would enable reduction of blood cultures by 37% and 52%, respectively, and still identify 96% and 88%, respectively, of positive blood cultures.Conclusions: Initial PCT level accurately predicted blood culture positivity in patients with CAP. PCT measurement has the potential to reduce the number of drawn blood cultures in the emergency department and to implement a more targeted allocation of limited health-care resources.