Uzzan Bernard, Cohen Régis, Nicolas Patrick, Cucherat Michel, Perret Gérard-Yves
APHP Laboratoire de Pharmacologie-Hormonologie, Hôpital Avicenne, Bobigny, France.
Crit Care Med. 2006 Jul;34(7):1996-2003. doi: 10.1097/01.CCM.0000226413.54364.36.
To quantify the accuracy of serum procalcitonin as a diagnostic test for sepsis, severe sepsis, or septic shock in adults in intensive care units or after surgery or trauma, alone and compared with C-reactive protein. To draw and compare the summary receiver operating characteristics curves for procalcitonin and C-reactive protein from the literature.
MEDLINE (keywords: procalcitonin, intensive care, sepsis, postoperative sepsis, trauma); screening of the literature.
Meta-analysis of all 49 published studies in medical, surgical, or polyvalent intensive care units or postoperative wards. Children, medical patients, and immunocompromised patients were excluded.
Thirty-three studies fulfilled inclusion criteria (3,943 patients, 1,828 males, 922 females; mean age: 56.1 yrs; 1,825 patients with sepsis, severe sepsis, or septic shock; 1,545 with only systemic inflammatory response syndrome); eight studies could not be analyzed statistically. Global mortality rate was 29.3%.
Global odds ratios for diagnosis of infection complicated by systemic inflammation were 15.7 for the 25 studies (2,966 patients) using procalcitonin (95% confidence interval, 9.1-27.1) and 5.4 for the 15 studies (1,322 patients) using C-reactive protein (95% confidence interval, 3.2-9.2). The summary receiver operating characteristics curve for procalcitonin was better than for C-reactive protein. In the 15 studies using both markers, the Q* value (intersection of summary receiver operating characteristics curve with the diagonal line where sensitivity equals specificity) was significantly higher for procalcitonin than for C-reactive protein (0.78 vs. 0.71, p = .02), the former test showing better accuracy.
Procalcitonin represents a good biological diagnostic marker for sepsis, severe sepsis, or septic shock, difficult diagnoses in critically ill patients. Procalcitonin is superior to C-reactive protein. Procalcitonin should be included in diagnostic guidelines for sepsis and in clinical practice in intensive care units.
量化血清降钙素原作为诊断重症监护病房、术后或创伤后成人脓毒症、严重脓毒症或脓毒性休克的诊断试验的准确性，单独使用以及与C反应蛋白比较。绘制并比较文献中降钙素原和C反应蛋白的汇总受试者工作特征曲线。
MEDLINE（关键词：降钙素原、重症监护、脓毒症、术后脓毒症、创伤）；文献筛选。
对医学、外科或多科重症监护病房或术后病房发表的所有49项研究进行荟萃分析。排除儿童、内科患者和免疫功能低下患者。
33项研究符合纳入标准（3943例患者，男性1828例，女性922例；平均年龄：56.1岁；1825例脓毒症、严重脓毒症或脓毒性休克患者；1545例仅有全身炎症反应综合征患者）；8项研究无法进行统计学分析。总体死亡率为29.3%。
使用降钙素原的25项研究（2966例患者）诊断感染合并全身炎症的总体优势比为15.7（95%置信区间，9.1 - 27.1），使用C反应蛋白的15项研究（1322例患者）为5.4（95%置信区间，3.2 - 9.2）。降钙素原的汇总受试者工作特征曲线优于C反应蛋白。在同时使用两种标志物的15项研究中，降钙素原的Q*值（汇总受试者工作特征曲线与灵敏度等于特异度的对角线的交点）显著高于C反应蛋白（0.78对0.71，p = 0.02），前一种试验显示出更好的准确性。
降钙素原是脓毒症、严重脓毒症或脓毒性休克的良好生物学诊断标志物，这些是危重症患者难以诊断的疾病。降钙素原优于C反应蛋白。降钙素原应纳入脓毒症诊断指南及重症监护病房的临床实践中。
