Stucker Fabien, Herrmann François, Graf Jean-Daniel, Michel Jean-Pierre, Krause Karl Heinz, Gavazzi Gaëtan
Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
J Am Geriatr Soc. 2005 Aug;53(8):1392-5. doi: 10.1111/j.1532-5415.2005.53421.x.
To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers.
Prospective observational study to compare PCT levels in infected and uninfected patients.
Geriatric teaching hospital in Switzerland.
Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit.
Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C-reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient.
Long-term corticotherapy, chronic immune diseases, fever of 38 degrees C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False-negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true-positive PCT. This finding may also be related to aging per se.
PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without.
比较降钙素原（PCT）与其他临床和生物学标志物在检测老年患者感染方面的效用。
比较感染和未感染患者PCT水平的前瞻性观察性研究。
瑞士的老年教学医院。
218名年龄在75岁及以上入住急性老年护理病房的老年患者。
前瞻性收集每位患者的人口统计学特征、合并症、Charlson指数、一般体征（呼吸频率、体温、脉搏率、意识模糊、跌倒、寒战）、全身炎症反应综合征（SIRS）、脓毒症、严重脓毒症、感染性休克、功能评分（功能独立性测量（FIM））、生物学参数（PCT、C反应蛋白（CRP）、白细胞、白蛋白）以及入院时的明确诊断。
长期皮质激素治疗、慢性免疫疾病、体温38摄氏度或更高、白细胞计数、脉搏率、FIM、SIRS、脓毒症、CRP 3mg/mL或更高以及PCT 0.5ng/mL或更高与入院时的感染相关。在多变量分析中，只有脓毒症和CRP 3mg/mL或更高仍与感染相关；PCT水平在多变量分析中未显示出任何显著关联。此外，当PCT具有良好的特异性（94%）时，其敏感性较低（24%）。与真阳性PCT相比，假阴性PCT与较低的感染严重程度（较低的炎症反应和较低的急性肾衰竭）相关。这一发现也可能与衰老本身有关。
PCT可能有助于识别入住急性老年病房的重症老年患者，但无助于区分感染患者和未感染患者。
