Boussekey N, Leroy O, Georges H, Devos P, d'Escrivan T, Guery B
Intensive Care and Infectious Disease Unit, Tourcoing Hospital, 135, rue du Président Coty - BP 619, 59208 Tourcoing cedex, France.
Infection. 2005 Aug;33(4):257-63. doi: 10.1007/s15010-005-4096-2.
Measurement of procalcitonin (PCT) has been studied for several years in infectious diseases. Some studies have focused on community-acquired pneumonia (CAP) but only one was conducted in critically ill patients hospitalized in an intensive care unit (ICU).
To determine the diagnostic and prognostic role of PCT in patients admitted in an intensive care unit for severe CAP, 110 patients hospitalized in our unit were prospectively studied. Within 48 hours following ICU admission, PCT serum level was measured with a quantitative method above a threshold value of 0.5 ng/ml.
Initially focusing on the diagnostic value of PCT, 20% of the patients had a serum PCT level <0.5 ng/ml, 30% between 0.5 ng/ml and 2 ng/ml, and 50%>/=2 ng/ml. Serum PCT level was higher in microbiologically documented CAP (median=4.9 ng/ml vs 1.5 ng/ml if no bacteria were found; p=0.001), but was not predictive of any specific bacterial agent. Concerning the prognostic value, the serum PCT level was higher for bacteremic patients and/or septic shock patients (4.9 ng/ml vs 1.5 ng/ml; p=0.0003). Moreover, PCT levels were increased in patients who developed, during their ICU stay, infection-related complications (septic shock, multiorgan dysfunction, acute respiratory distress syndrome and disseminated intravascular coagulation). Finally, the initial PCT level was significantly higher in patients who died during the ICU stay (5.6 ng/ml vs 1.5 ng/ml; p<0.0001). Such a relationship was not found with C-reactive protein (CRP).
In ICU patients admitted for severe CAP, initial PCT values could be an interesting predictor for complications and mortality.
降钙素原（PCT）的检测在传染病领域已研究多年。一些研究聚焦于社区获得性肺炎（CAP），但仅有一项研究是针对入住重症监护病房（ICU）的危重症患者开展的。
为确定PCT在因重症CAP入住ICU患者中的诊断及预后价值，对我院收治的110例患者进行了前瞻性研究。在入住ICU后48小时内，采用定量方法检测PCT血清水平，阈值设定为0.5 ng/ml以上。
最初关注PCT的诊断价值，20%的患者血清PCT水平<0.5 ng/ml，30%在0.5 ng/ml至2 ng/ml之间，50%≥2 ng/ml。微生物学确诊的CAP患者血清PCT水平更高（中位数=4.9 ng/ml，未发现细菌时为1.5 ng/ml；p=0.001），但不能预测任何特定细菌病原体。关于预后价值，菌血症患者和/或感染性休克患者的血清PCT水平更高（4.9 ng/ml对1.5 ng/ml；p=0.0003）。此外，在ICU住院期间发生感染相关并发症（感染性休克、多器官功能障碍、急性呼吸窘迫综合征和弥散性血管内凝血）的患者中，PCT水平升高。最后，在ICU住院期间死亡的患者初始PCT水平显著更高（5.6 ng/ml对1.5 ng/ml；p<0.0001）。而C反应蛋白（CRP）未发现这种关系。
在因重症CAP入住ICU的患者中，初始PCT值可能是并发症和死亡率的一个有意义的预测指标。
