Multicenter prospective study of procalcitonin as an indicator of sepsis
Multicenter prospective study of procalcitonin as an indicator of sepsis
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DOI：
10.1007/s10156-005-0388-9
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发表时间：
2005-06-01
影响因子：
2.2
通讯作者：
Satomura, Shinji
中科院分区：
文献类型：
--
作者：
Aikawa, Naoki;Fujishima, Seitaro;Satomura, Shinji
在一项多中心前瞻性研究中，比较了血清降钙素原（PCT）与内毒素、β-D-葡聚糖、白细胞介素（IL）-6和C-反应蛋白（CRP）在区分细菌性感染性疾病和非细菌性感染性疾病（如全身炎症反应综合征（SIRS））中的临床意义。全身性细菌感染和局限性细菌感染患者的PCT浓度显著高于非细菌感染或非感染性疾病患者。细菌性感染组PCT、内毒素、IL-6和CRP水平均显著高于非细菌性感染组（P < 0.001、P < 0.005、P < 0.001和P < 0.001）。PCT鉴别细菌性与非细菌性感染的临界值为0.5ng/ml，敏感性为64.4%，特异性为86.0%。细菌感染性疾病与非细菌感染性疾病合并组PCT、内毒素、IL-6和CRP的ROC曲线下面积分别为0.84、0.60、0.77和0.78，PCT的ROC曲线下面积显著高于内毒素（P < 0.001）。在临床诊断为菌血症的患者中，PCT诊断阳性率为70.2%，血培养阳性率为42.6%。因此，PCT对于区分细菌感染与SIRS是必不可少的，并且在这方面上级传统的血清标志物和血培养。
The clinical significance of serum procalcitonin (PCT) for discriminating between bacterial infectious disease and nonbacterial infectious disease (such as systemic inflammatory response syndrome (SIRS)), was compared with the significance of endotoxin, beta-D-glucan, interleukin (IL)-6, and C-reactive protein (CRP) in a multicenter prospective study. The concentrations of PCT in patients with systemic bacterial infection and those with localized bacterial infection were significantly higher than the concentrations in patients with nonbacterial infection or noninfectious diseases. In addition, PCT, endotoxin, IL-6 and CRP concentrations were significantly higher in patients with bacterial infectious disease than in those with nonbacterial infectious disease (P < 0.001, P < 0.005 P < 0.001, and P < 0.001, respectively). The cutoff value of PCT for the discrimination of bacterial and nonbacterial infectious diseases was determined to be 0.5ng/ml, which was associated with a sensitivity of 64.4% and specificity of 86.0%. Areas under the receiver operating characteristic curves (POCs) were 0.84 for PCT, 0.60 for endotoxin, 0.77 for IL-6, and 0.78 for CRP in the combined group of patients with bacterial infectious disease and those with nonbacterial infectious disease, and the area under the ROC for PCT was significantly higher than that for endotoxin (P < 0.001). In patients diagnosed with bacteremia based on clinical findings, the positive rate of diagnosis with PCT was 70.2%, while that of blood culture was 42.6%. PCT is thus essential for discriminating bacterial infection from SIRS, and is superior in this respect to conventional serum markers and blood culture.