Procalcitonin as a Marker of Etiology in Adults Hospitalized With Community-Acquired Pneumonia.
Procalcitonin as a Marker of Etiology in Adults Hospitalized With Community-Acquired Pneumonia.
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DOI：
10.1093/cid/cix317
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发表时间：
2017-07-15
期刊：
影响因子：
--
通讯作者：
Wunderink RG
中科院分区：
文献类型：
--
作者：
Self WH;Balk RA;Grijalva CG;Williams DJ;Zhu Y;Anderson EJ;Waterer GW;Courtney DM;Bramley AM;Trabue C;Fakhran S;Blaschke AJ;Jain S;Edwards KM;Wunderink RG
最近的试验表明，以降钙素原为基础的指导方针可以减少呼吸道感染的抗生素使用。然而，降钙素原鉴别病毒性肺炎和细菌性肺炎的准确性有待进一步研究。最近的试验表明，以降钙素原为基础的指导方针可以减少呼吸道感染的抗生素使用。然而，降钙素原鉴别病毒性肺炎和细菌性肺炎的准确性有待进一步研究。我们评估了入院时血清降钙素原浓度与社区获得性肺炎住院成人多中心前瞻性监测研究中检测到的病原体之间的关系。系统的病原体检测包括培养、血清学、尿抗原检测和分子检测。计算了降钙素原区分病毒性和细菌性病原体的准确性。1735例患者中检出病原菌645例（37%），其中典型细菌169例（10%），非典型细菌67例（4%），单纯病毒409例（24%）。病毒致病菌降钙素原浓度中位数（0.09 ng/mL，四分位间距[IQR]， <0.05 ~ 0.54 ng/mL）低于非典型细菌（0.20 ng/mL， IQR, <0.05 ~ 0.87 ng/mL, P = 0.05）和典型细菌（2.5 ng/mL， IQR, 0.29 ~ 12.2 ng/mL, P < 0.01）。降钙素原区分细菌性病原体（包括典型和非典型细菌）与病毒性病原体的ROC曲线下面积为0.73（95%可信区间[CI]， 0.69 - 0.77）。降钙素原阈值为0.1 ng/mL，对任何细菌病原体的敏感性为80.9% (95% CI, 75.3%-85.7%)，特异性为51.6% （95% CI, 46.6%-56.5%）。降钙素原区分典型细菌和病毒与非典型细菌的组合，ROC曲线下面积为0.79 （95% CI, 0.75 - 0.82）。没有降钙素原阈值可以完全区分病毒性病原体和细菌性病原体，但较高的降钙素原阈值与细菌性病原体，特别是典型细菌的可能性增加密切相关。
Recent trials suggest procalcitonin-based guidelines can reduce antibiotic use for respiratory infections. However, the accuracy of procalcitonin to discriminate between viral and bacterial pneumonia requires further dissection. Recent trials suggest procalcitonin-based guidelines can reduce antibiotic use for respiratory infections. However, the accuracy of procalcitonin to discriminate between viral and bacterial pneumonia requires further dissection. We evaluated the association between serum procalcitonin concentration at hospital admission with pathogens detected in a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia. Systematic pathogen testing included cultures, serology, urine antigen tests, and molecular detection. Accuracy of procalcitonin to discriminate between viral and bacterial pathogens was calculated. Among 1735 patients, pathogens were identified in 645 (37%), including 169 (10%) with typical bacteria, 67 (4%) with atypical bacteria, and 409 (24%) with viruses only. Median procalcitonin concentration was lower with viral pathogens (0.09 ng/mL; interquartile range [IQR], <0.05–0.54 ng/mL) than atypical bacteria (0.20 ng/mL; IQR, <0.05–0.87 ng/mL; P = .05), and typical bacteria (2.5 ng/mL; IQR, 0.29–12.2 ng/mL; P < .01). Procalcitonin discriminated bacterial pathogens, including typical and atypical bacteria, from viral pathogens with an area under the receiver operating characteristic (ROC) curve of 0.73 (95% confidence interval [CI], .69–.77). A procalcitonin threshold of 0.1 ng/mL resulted in 80.9% (95% CI, 75.3%–85.7%) sensitivity and 51.6% (95% CI, 46.6%–56.5%) specificity for identification of any bacterial pathogen. Procalcitonin discriminated between typical bacteria and the combined group of viruses and atypical bacteria with an area under the ROC curve of 0.79 (95% CI, .75–.82). No procalcitonin threshold perfectly discriminated between viral and bacterial pathogens, but higher procalcitonin strongly correlated with increased probability of bacterial pathogens, particularly typical bacteria.
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DOI：
10.1016/s0140-6736(10)61459-6
发表时间：
2011-04-09
期刊：
Lancet (London, England)
影响因子：
--
作者：
Ruuskanen O;Lahti E;Jennings LC;Murdoch DR
通讯作者：
Murdoch DR
影响因子：
11.8
作者：
Gilbert, David N.
通讯作者：
Gilbert, David N.
DOI：
10.1164/rccm.200512-1922oc
发表时间：
2006-07-01
影响因子：
24.7
作者：
Christ-Crain, Miriam;Stolz, Daiana;Mueller, Beat
通讯作者：
Mueller, Beat
影响因子：
4.8
作者：
Linscheid, P;Seboek, D;Müller, B
通讯作者：
Müller, B
影响因子：
6.4
作者：
Dare, Ryan K.;Fry, Alicia M.;Erdman, Dean D.
通讯作者：
Erdman, Dean D.