Can serum procalcitonin levels help interpret indeterminate chest radiographs in patients hospitalized with acute respiratory illness?
Can serum procalcitonin levels help interpret indeterminate chest radiographs in patients hospitalized with acute respiratory illness?
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DOI：
10.1002/jhm.1984
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发表时间：
2013-02-01
影响因子：
2.6
通讯作者：
Falsey, Ann R.
中科院分区：
文献类型：
--
作者：
Walsh, Edward E.;Swinburne, Andrew J.;Falsey, Ann R.
背景肺炎的临床诊断困难，胸部X线检查往往不确定，导致误诊和抗生素滥用。目的探讨血清降钙素原（ProCT）对呼吸系统疾病和X线不确定性的诊断价值。设计研究对象为连续2个冬季的前瞻性研究对象。场景设置在纽约州罗切斯特一家拥有520个床位的医院。528名患有急性呼吸道疾病的成年人入选。血清ProCT、入院诊断和胸部放射学检查结果用于推导受试者工作特征曲线，以评估ProCT对浸润性病变的预测准确性。结果肺炎受试者的ProCT（中位数0.27 ng/ml）高于慢性阻塞性肺病（0.08 ng/ml）、急性支气管炎（0.09 ng/ml）或哮喘（0.06 ng/ml）加重的受试者。当不确定的X线片被评估患者的肺病学家独立分类为浸润时，ProCT对浸润存在的准确性中等（曲线下面积[AUC] 0.72）。结论：当胸片不能确定时，ProCT可能有助于诊断肺炎。医院医学杂志2013;8：6167。(c)2012医院医学学会
BACKGROUND Clinical diagnosis of pneumonia is difficult and chest radiographs often indeterminate, leading to incorrect diagnoses and antibiotic overuse. OBJECTIVE To determine if serum procalcitonin (ProCT) could assist in managing patients with respiratory illness and indeterminate radiographs. DESIGN Subjects were prospectively enrolled during 2 consecutive winters. SETTING A 520-bed hospital in Rochester, NY. PATIENTS Five hundred twenty-eight adults admitted with acute respiratory illness were enrolled. MEASUREMENTS Serum ProCT, admission diagnoses, and chest radiographic findings were used to derive receiver operating characteristics curves to assess predictive accuracy of ProCT for the presence of infiltrates. RESULTS Subjects with pneumonia had higher ProCT (median 0.27 ng/ml) than those with exacerbations of chronic obstructive pulmonary disease (0.08 ng/ml), acute bronchitis (0.09 ng/ml), or asthma (0.06 ng/ml). ProCT had moderate accuracy for the presence of infiltrates (area under curve [AUC] 0.72), when indeterminate radiographs were independently classified as infiltrates by a pulmonologist evaluating patients. CONCLUSIONS ProCT may be useful in diagnosing pneumonia when chest radiographs are indeterminate. Journal of Hospital Medicine 2013;8:6167. (c) 2012 Society of Hospital Medicine