Gibot Sebastien, Cravoisy Aurelie, Dupays Rachel, Barraud Damien, Nace Lionel, Levy Bruno, Bollaert Pierre-Edouard
Service de Réanimation Médicale, Hôpital Central, Nancy, France.
Scand J Infect Dis. 2007;39(6-7):604-8. doi: 10.1080/00365540701199832.
This prospective, non-interventional study was conducted in a medical adult intensive care unit to determine the usefulness of procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) determinations in the diagnosis of nosocomial sepsis. Serum PCT and bronchoalveolar lavage fluid sTREM-1 concentrations were measured in 50 critically ill patients suffering from nosocomial sepsis. Ventilator-associated pneumonia (VAP) was diagnosed in 31 patients and extrapulmonary sepsis in 19. Increase serum PCT concentration (>0.15 ng/ml) was found in 44 (88%) patients and was higher in those suffering from a non-pulmonary sepsis. The concomitant BAL sTREM-1 determination correctly classified pulmonary (VAP) versus non-pulmonary origin in 41 out of 44 cases (93%). Even when PCT concentration remained low, sTREM-1 assessment allowed for the detection of the sepsis (VAP) in 50% of cases. Both PCT and sTREM-1 concentrations were low in only 3 patients (6%) in whom sepsis could have been missed if only diagnosed by the measurement of these 2 biomarkers. We therefore concluded that the combined measurement of serum PCT and BAL sTREM-1 concentrations could be of interest in detecting the presence of a nosocomial sepsis and in discriminating VAP versus extrapulmonary infection.
这项前瞻性非干预性研究在一个成人医学重症监护病房进行，以确定降钙素原（PCT）和髓系细胞表面可溶性触发受体-1（sTREM-1）检测在医院获得性脓毒症诊断中的作用。对50例患有医院获得性脓毒症的重症患者测定了血清PCT和支气管肺泡灌洗液sTREM-1浓度。31例患者诊断为呼吸机相关性肺炎（VAP），19例为肺外脓毒症。44例（88%）患者血清PCT浓度升高（>0.15 ng/ml），非肺源性脓毒症患者的PCT浓度更高。在44例中的41例（93%）中，同时进行的支气管肺泡灌洗sTREM-1检测能正确区分肺部（VAP）与非肺部来源。即使PCT浓度保持较低水平，sTREM-1检测仍能在50%的病例中检测出脓毒症（VAP）。仅3例（6%）患者的PCT和sTREM-1浓度均较低，如果仅通过这两种生物标志物检测，这些患者可能会漏诊脓毒症。因此，我们得出结论，联合检测血清PCT和支气管肺泡灌洗sTREM-1浓度可能有助于检测医院获得性脓毒症的存在，并区分VAP与肺外感染。
