Discrimination of infectious and noninfectious causes of early acute respiratory distress syndrome by procalcitonin
Discrimination of infectious and noninfectious causes of early acute respiratory distress syndrome by procalcitonin
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DOI：
10.1097/00003246-199910000-00016
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发表时间：
1999-10-01
影响因子：
8.8
通讯作者：
Brunkhorst, R
中科院分区：
文献类型：
--
作者：
Brunkhorst, FM;Eberhard, OK;Brunkhorst, R
目的：为了测试脓毒症标志物降钙素原（PCT）的适用性，以区分脓毒症和非脓毒症的原因急性呼吸窘迫综合征（ARDS）设计：前瞻性研究，评估过程中的PCT血清水平在早期（发病后72小时内）ARDS。另外三种炎症标志物新蝶呤、白细胞介素-6（IL-6）和C反应蛋白（CRP）也进行了平行检测。设置：一家拥有1，990张床位的基层医院的24张床位的重症监护室，为大约39，000名患者提供医疗保健。27名患者，18名男性和9名女性，年龄16-85岁，患有已知原因的早期ARDS 1994年5月至1995年5月，17例脓毒性ARDS患者和10例非脓毒性ARDS患者参加了一项前瞻性研究。每4-6小时采集一次血清样本，用于测量PCT、新蝶呤、IL-6和CRP浓度。每12-24小时采集一次孵育培养物、气管抽吸物和尿液样本。27例患者中有24例还获得了支气管镜培养。根据美国胸科医师学会/重症监护医学会共识会议定义的临床脓毒症标准，每天进行检查。测量和主要结果：评估脓毒症与非脓毒症ARDS患者的炎症标志物血清水平。在ARDS发病后72小时内，脓毒性ARDS患者的PCT血清水平显著高于非脓毒性ARDS患者（p <0.0005）。两组之间没有重叠。此外，新蝶呤允许区分（p <0.005），虽然观察到脓毒症和非脓毒症患者的血清水平之间有实质性重叠。结论：PCT测定有助于区分早期ARDS患者的脓毒症和非脓毒症基础疾病。
Objective: To test the sepsis marker procalcitonin (PCT) for its applicability to discriminate between septic and nonseptic causes of acute respiratory distress syndrome (ARDS).Design: Prospective study, assessing the course of PCT serum levels in early (within 72 hrs after onset) ARDS. The three other inflammation markers neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP) were tested in parallel.Setting: Twenty-four-bed medical intensive care unit of a 1,990-bed primary hospital, providing health care for an estimated 39,000 patients.Patients: Twenty-seven patients, 18 male and nine female, aged 16-85 yrs, with early ARDS of known cause (17 with septic and ten with nonseptic ARDS) were enrolled in a prospective study between May 1994 and May 1995.Interventions: Serum samples were drawn every 4-6 hrs for measurement of PCT, neopterin, IL-6, and CRP concentrations. Brood cultures, tracheal aspirates, and urine samples were obtained every 12-24 hrs. In 24 of 27 patients, bronchoscopic cultures were also obtained. Clinical sepsis criteria as defined by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference were checked daily.Measurements and Main Results: Assessment of inflammation marker serum levels in septic vs, nonseptic ARDS. PCT serum levels were significantly higher (p < .0005) in the patients with septic ARDS than in patients with nonseptic ARDS within 72 hrs after onset of ARDS. There was no overlap between the two groups. Also, neopterin allowed a differentiation (p < .005), although a substantial overlap between serum levels of septic and nonseptic patients was observed. No discrimination could be achieved by determination of GRP and IL-6 levels.Conclusion: PCT determination in early ARDS could help to discriminate between septic and nonseptic underlying disease.