Mills G D, Lala H M, Oehley M R, Craig A B, Barratt K, Hood D, Thornley C N, Nesdale A, Manikkam N E, Reeve P
Infectious Diseases Department, Waikato Hospital, Private Bag 3200, Hamilton, New Zealand.
Eur J Clin Microbiol Infect Dis. 2006 Aug;25(8):501-9. doi: 10.1007/s10096-006-0179-y.
Patients with meningococcal disease who seek medical attention can create a diagnostic dilemma for clinicians due to the nonspecific nature of the disease's presentation. This study assesses the diagnostic accuracy of procalcitonin levels in the setting of meningococcal disease. Two emergency department cohorts (A and B) were studied between 2002 and 2005, during the current epidemic of serogroup B meningococcal disease in New Zealand. Cohort A consisted of 171 patients, all with confirmed meningococcal disease (84 children, 87 adults). Cohort B consisted of a large (n=1,524) consecutively recruited population of febrile patients who presented to the emergency department, 28 of whom had confirmed meningococcal disease. Within the meningococcal disease cohort (cohort A), the geometric mean procalcitonin level was 9.9 ng/ml, with levels being higher in children than in adults (21.6 vs. 4.6 ng/ml, p=0.01). The overall sensitivity of elevated procalcitonin, using a cutoff of 2.0 ng/ml in children and 0.5 ng/ml in adults, was 0.93 (95%CI: 0.88-0.96). Despite the higher cutoff level for paediatric patients, a trend towards greater sensitivity existed in children (0.96 vs. 0.90; p=0.08). Elevated procalcitonin was correlated with whole blood meningococcal load (r=0.50) and Glasgow Meningococcal Sepsis Prognostic Score (r=0.40). Within the cohort of patients who were febrile on presentation (cohort B), the specificity of elevated procalcitonin in meningococcal disease was 0.85 (95% CI: 0.83-0.87), the positive and negative likelihood ratios were 6.1 and 0.08, respectively, and the sensitivity of elevated procalcitonin (0.93; 95% CI: 0.76-0.99) was corroborated. Measurement of procalcitonin is a useful tool in patients with nonspecific febrile illnesses when the possibility of meningococcal disease is present. The diagnostic accuracy surpasses that of current early laboratory markers, allowing results to be used to guide decisions about patient management.
因脑膜炎球菌病的临床表现不具特异性，寻求医疗救治的脑膜炎球菌病患者会给临床医生带来诊断难题。本研究评估降钙素原水平在脑膜炎球菌病诊断中的准确性。在2002年至2005年期间，新西兰B群脑膜炎球菌病当前流行期间，对两个急诊科队列（A和B）进行了研究。队列A由171例患者组成，均确诊为脑膜炎球菌病（84例儿童，87例成人）。队列B由大量（n = 1524）连续招募的到急诊科就诊的发热患者组成，其中28例确诊为脑膜炎球菌病。在脑膜炎球菌病队列（队列A）中，降钙素原几何平均水平为9.9 ng/ml，儿童水平高于成人（21.6对4.6 ng/ml，p = 0.01）。以儿童2.0 ng/ml、成人0.5 ng/ml为临界值，降钙素原升高的总体敏感性为0.93（95%CI：0.88 - 0.96）。尽管儿科患者的临界值更高，但儿童中存在更高敏感性的趋势（0.96对0.90；p = 0.08）。降钙素原升高与全血脑膜炎球菌载量（r = 0.50）和格拉斯哥脑膜炎球菌败血症预后评分（r = 0.40）相关。在就诊时发热的患者队列（队列B）中，降钙素原升高在脑膜炎球菌病中的特异性为0.85（95%CI：0.83 - 0.87），阳性和阴性似然比分别为6.1和0.08，降钙素原升高的敏感性（0.93；95%CI：0.76 - 0.99）得到了证实。当存在脑膜炎球菌病可能性时，降钙素原检测对于非特异性发热疾病患者是一种有用的工具。其诊断准确性超过了当前早期实验室标志物，可用于指导患者管理决策。
