Van der Kaay D C M, De Kleijn E D, De Rijke Y B, Hop W C J, De Groot R, Hazelzet J A
Department of Paediatrics, Division of Paediatric Intensive Care, Erasmus Medical Center/Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
Intensive Care Med. 2002 Nov;28(11):1606-12. doi: 10.1007/s00134-002-1505-1. Epub 2002 Oct 4.
To assess the prognostic value of procalcitonin levels during the clinical course of meningococcal disease in children.
A retrospective, descriptive study.
University paediatric intensive care unit.
Nine patients with meningococcal sepsis and 55 patients with meningococcal septic shock were included in the study, giving a total of 64.
Procalcitonin (PCT), C-reactive protein (CRP), cytokines (IL-6, IL-8 and TNF-alpha), plasminogen activator inhibitor-1 (PAI-1) and several routine laboratory parameters were determined and expressed as medians (ranges). PCT levels on hospitalisation were elevated in all children as compared to normal values. Median PCT levels on admission were significantly higher in children with septic shock than in children with sepsis (270 ng/ml (5.7-672.3) versus 64.4 (20.6-283.7); p<0.01). When the patients were categorised to severity using the Pediatric Risk of Mortality (PRISM) score (group 1: <15 points, group 2: 16-30, group 3: >30), the PCT levels were significantly different in the three groups. All markers, with the exception of PCT (p=0.056), were significantly different between survivors and non-survivors. When the duration of petechiae was taken into account, the difference in PCT levels became significant (p=0.04).
Procalcitonin levels on admission are related to severity. In the case of a short disease history (duration of petechiae), PCT levels are also related to mortality. Although PCT levels are elevated in all patients, the levels per se do not allow a prediction about survival versus non-survival, this is in contrast to other markers and scores (PRISM).
评估降钙素原水平在儿童脑膜炎球菌病临床病程中的预后价值。
一项回顾性描述性研究。
大学儿科重症监护病房。
本研究纳入了9例脑膜炎球菌败血症患儿和55例脑膜炎球菌感染性休克患儿，共64例。
测定了降钙素原（PCT）、C反应蛋白（CRP）、细胞因子（IL-6、IL-8和TNF-α）、纤溶酶原激活物抑制剂-1（PAI-1）以及一些常规实验室参数，并以中位数（范围）表示。与正常值相比，所有患儿入院时的PCT水平均升高。感染性休克患儿入院时的PCT中位数水平显著高于败血症患儿（270 ng/ml（5.7 - 672.3）对64.4（20.6 - 283.7）；p<0.01）。当使用儿童死亡风险（PRISM）评分将患者分为不同严重程度组时（第1组：<15分，第2组：16 - 30分，第3组：>30分），三组的PCT水平有显著差异。除PCT外（p = 0.056），所有标志物在幸存者和非幸存者之间均有显著差异。当考虑瘀点持续时间时，PCT水平的差异变得显著（p = 0.04）。
入院时的降钙素原水平与疾病严重程度相关。在疾病史较短（瘀点持续时间）的情况下，PCT水平也与死亡率相关。尽管所有患者的PCT水平均升高，但该水平本身并不能预测生存与否，这与其他标志物和评分（PRISM）不同。
