Procalcitonin kinetics early after severe burn injury and its value in diagnosis of sepsis.
Procalcitonin kinetics early after severe burn injury and its value in diagnosis of sepsis.
复制标题
严重烧伤后早期降钙素原动力学及其在脓毒症诊断中的价值
DOI：
10.1016/j.burns.2021.02.024
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发表时间：
2021-12-01
期刊：
影响因子：
--
通讯作者：
Luo, Gaoxing
中科院分区：
文献类型：
--
作者：
Tan, Jianglin;Li, Ning;Luo, Gaoxing
目得：探讨烧伤后早期和围手术期降钙素原（PCT）动力学的临床意义，并评估其对严重烧伤患者脓毒症的诊断性能。方法：对2014年至2019年在中国重庆西南医院收治的严重烧伤患者（≥40%总体表面积）进行回顾性研究。共纳入321例患者。在烧伤后第1周、围手术期和临床怀疑脓毒症发作时分析PCT的动力学。与烧伤后第1周PCT水平升高相关的因素包括烧伤面积较大（>70% TBSA）和年龄较低（≤14岁）。观察了烧伤后PCT动力学与早期脓毒症发展和死亡率的相关性。在脓毒症发病时，血清PCT与诊断前48小时的基础水平相比显著升高。PCT浓度及其动力学变化的受试者工作特征曲线下面积分别为0.788和0.826。PCT动力学在区分革兰氏阳性脓毒症方面显示出比PCT浓度更好的准确性。PCT浓度及其动力学的最佳诊断阈值为1.41 ng/mL，和1.34倍的升高相比，基线level.CONCLUSIONS：PCT动力学在烧伤后的早期阶段是脓毒症和死亡率之间的主要烧伤患者的预后因素。血清PCT水平可作为严重烧伤患者脓毒症的诊断生物标志物。
PURPOSE: To investigate the clinical significance of procalcitonin (PCT) kinetics early after burn and the perioperative period, and to assess its diagnostic performance for sepsis in major burn patients.METHODS: This retrospective study on major burn patents (≥40% total body surface area) admitted from 2014 to 2019 was conducted in Southwest Hospital, Chongqing, China. A total of 321 patients were included. The kinetics of PCT was analyzed during the 1st week after burn, the perioperative period, and at the onset of clinical suspected sepsis.RESULTS: Serum PCT concentration rose immediately after burn injury. Factors associated with increased PCT level in the 1st week after burn include greater burn area (>70% TBSA) and lower age (≤14 years). Correlations between PCT kinetics after burn and the risk of early development of sepsis and mortality were observed. At the onset of sepsis, serum PCT increased significantly compared to its basal level in the 48 h before diagnosis. The area under the receiver operating characteristics curve of PCT concentration and its kinetic changes was 0.788 and 0.826, respectively. PCT kinetics showed better accuracy than PCT concentration in discrimination of Gram-positive sepsis. The optimal diagnostic thresholds for PCT concentration and its kinetics were 1.41 ng/mL, and a 1.34-fold elevation compared to the baseline level.CONCLUSIONS: PCT kinetics in the early stage after burn was a prognostic factor for sepsis and mortality among major burn patients. Serum PCT levels could be a diagnostic biomarker for sepsis in major burn patients.