Oconnor E, Venkatesh B, Mashongonyika C, Lipman J, Hall J, Thomas P
Department of Intensive Care, Royal Brisbane Hospital, Queensland.
Anaesth Intensive Care. 2004 Aug;32(4):465-70. doi: 10.1177/0310057X0403200402.
This prospective study evaluated serum procalcitonin (PCT) and C-reactive protein (CRP) as markers for systemic inflammatory response syndrome (SIRS)/sepsis and mortality in patients with traumatic brain injury and subarachnoid haemorrhage. Sixty-two patients were followed for 7 days. Serum PCT and CRP were measured on days 0, 1, 4, 5, 6 and 7. Seventy-seven per cent of patients with traumatic brain injury and 83% with subarachnoid haemorrhage developed SIRS or sepsis (P=0.75). Baseline PCT and CRP were elevated in 35% and 55% of patients respectively (P=0.03). There was a statistically non-significant step-wise increase in serum PCT levels from no SIRS (0.4+/-0.6 ng/ml) to SIRS (3.05+/-9.3 ng/ml) to sepsis (5.5+/-12.5 ng/ml). A similar trend was noted in baseline PCT in patients with mild (0.06+/-0.9 ng/ml), moderate (0.8+/-0.7 ng/ml) and severe head injury (1.2+/-1.9 ng/ml). Such a gradation was not observed with serum CRP There was a non-significant trend towards baseline PCT being a better marker of hospital mortality compared with baseline CRP (ROC-AUC 0.56 vs 0.31 respectively). This is the first prospective study to document the high incidence of SIRS in neurosurgical patients. In our study, serum PCT appeared to correlate with severity of traumatic brain injury and mortality. However, it could not reliably distinguish between SIRS and sepsis in this cohort. This is in part because baseline PCT elevation seemed to correlate with severity of injury. Only a small proportion of patients developed sepsis, thus necessitating a larger sample size to demonstrate the diagnostic usefulness of serum PCT as a marker of sepsis. Further clinical trials with larger sample sizes are required to confirm any potential role of PCT as a sepsis and outcome indicator in patients with head injuries or subarachnoid haemorrhage.
这项前瞻性研究评估了血清降钙素原（PCT）和C反应蛋白（CRP）作为创伤性脑损伤和蛛网膜下腔出血患者全身炎症反应综合征（SIRS）/脓毒症及死亡率的标志物。62例患者被随访7天。在第0、1、4、5、6和7天测量血清PCT和CRP。77%的创伤性脑损伤患者和83%的蛛网膜下腔出血患者发生了SIRS或脓毒症（P=0.75）。分别有35%和55%的患者基线PCT和CRP升高（P=0.03）。血清PCT水平从无SIRS（0.4±0.6 ng/ml）到SIRS（3.05±9.3 ng/ml）再到脓毒症（5.5±12.5 ng/ml）有统计学上无显著意义的逐步升高。轻度（0.06±0.9 ng/ml）、中度（0.8±0.7 ng/ml）和重度颅脑损伤患者的基线PCT也有类似趋势（1.2±1.9 ng/ml）。血清CRP未观察到这种分级。与基线CRP相比，基线PCT作为医院死亡率更好标志物的趋势不显著（ROC-AUC分别为0.56和0.31）。这是第一项记录神经外科患者SIRS高发病率的前瞻性研究。在我们的研究中，血清PCT似乎与创伤性脑损伤的严重程度和死亡率相关。然而，它不能可靠地区分该队列中的SIRS和脓毒症。部分原因是基线PCT升高似乎与损伤严重程度相关。只有一小部分患者发生脓毒症，因此需要更大样本量来证明血清PCT作为脓毒症标志物的诊断价值。需要进行更大样本量的进一步临床试验，以确认PCT作为头部损伤或蛛网膜下腔出血患者脓毒症和预后指标的任何潜在作用。
