Indino Pamela, Lemarchand Pierre, Bady Pierre, de Torrenté Antoine, Genné Louis, Genné Daniel
Département de médecine interne, Hôpital de la ville, rue du Chasseral 20, 2300 La Chaux-de-Fonds, Switzerland.
Int J Infect Dis. 2008 May;12(3):319-24. doi: 10.1016/j.ijid.2007.09.007. Epub 2008 Feb 20.
To better assess the diagnosis of an infection in patients presenting at an emergency department with peripheral blood leukocytosis (>10 x 10(9) cells/l) on laboratory testing.
We prospectively evaluated serum procalcitonin concentration (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Patients were divided into two groups according to their final diagnosis: patients with infection and those without infection. PCT, CRP, and ESR were compared between these groups. Sensitivity, specificity, positive predictive values, negative predictive values, receiver operating characteristic curves, and areas under the curves were calculated for each biological measurement.
Out of 173 patients, 99 (57%) had a final diagnosis of systemic infection. If a cutoff point of 0.5 ng/ml is considered, procalcitonin concentration had a sensitivity of 0.57, a specificity of 0.85, a negative predictive value of 0.59, and a positive predictive value of 0.84 for the diagnosis of a systemic infection. Adding CRP or ESR to PCT gave no more information (p=0.84).
Only about half of the patients attending the emergency department with leukocytosis were suffering from an infection. Determination of the procalcitonin level may be useful for these patients, particularly in the case of a value higher than 0.5 ng/ml.
为了更好地评估在急诊科就诊且实验室检查显示外周血白细胞增多（>10×10⁹个细胞/升）的患者是否感染。
我们前瞻性地评估了血清降钙素原浓度（PCT）、C反应蛋白（CRP）和红细胞沉降率（ESR）。根据最终诊断将患者分为两组：感染患者和非感染患者。比较两组之间的PCT、CRP和ESR。计算每种生物学检测指标的敏感性、特异性、阳性预测值、阴性预测值、受试者工作特征曲线和曲线下面积。
173例患者中，99例（57%）最终诊断为全身感染。如果将0.5 ng/ml作为截断点，降钙素原浓度对全身感染诊断的敏感性为0.57，特异性为0.85，阴性预测值为0.59，阳性预测值为0.84。将CRP或ESR加入PCT检测未提供更多信息（p = 0.84）。
在急诊科就诊的白细胞增多患者中，只有约一半患有感染。对于这些患者，降钙素原水平测定可能有用，特别是当值高于0.5 ng/ml时。
