Xing Yu-Bin, Dai Lu-Ming, Zhao Zhi-Huan, Li Zhi-Wei, Li Chao
Departement of Respiratory Disease, The First Affiliated Hospital of Kunming Medical College, Kunming 650032, Yunnan, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2008 Jan;20(1):23-8.
To study the diagnostic and prognostic value of procalcitonin (PCT), common inflammatory markers combining with scores for estimating organ failure of infection related organs (SOFA) in patients with sepsis in early stage.
Patients were observed continuously in a perspective study with diagnostic tests. According to the definition of ACCP/SCCM Consensus Conference, patients were classified into 5 groups, including non-systemic inflammatory response syndrome (SIRS) (control) group, SIRS group, sepsis group, severe sepsis group and septic shock group. Indexes of inflammation, SOFA and concentration of PCT were determined at 24 hours, and their correlation was analyzed.
Two hundred and eight patients were enrolled, including 59 in non-SIRS group, 57 in SIRS group, 52 in sepsis group, 28 in severe sepsis group and 12 in septic shock group. PCT concentrations were positively correlated with the severity of sepsis. Spearman's correlation coefficient was 0.909 (P=0.000). According to the receiver operating characteristic curves (ROC-curves) analysis principle, ROC curves were drawn and areas under these curves (AUC) was calculated. In the diagnosis of sepsis, AUC values were 0.936+/-0.020 for PCT, 0.973+/-0.011 for SOFA (both P=0.000). The best cutoff values in the diagnosis of sepsis were 0.375 microg/L for PCT, and 3. 5 for SOFA score. The Youden index of PCT and SOFA scores was 0.808 and 0.801, respectively. Binary Logistic regression analysis confirmed that PCT and SOFA score were highly correlated with sepsis (OR=84.794,10.761, respectively, both P=0.000) after eliminating confusion factors including age and C-reactive protein (CRP) etc.. PCT and SOFA score could be used to predict the incidence of sepsis. SOFA score was the best prognostic indicator of sepsis (OR=2.084, P=0.0002).
The traditional inflammatory markers and CRP are useful parameters to differentiate SIRS from non-SIRS, but are not reliable indicators for the early diagnosis in patients with sepsis. PCT is more specific indicator in early diagnosis of sepsis to differentiate from SIRS. PCT combining with SOFA score can be used to predict the incidence of sepsis. SOFA score can be used to define objectively the severity of sepsis according to PCT level and is helpful for estimation of prognosis in patients with sepsis.
探讨降钙素原（PCT）、常见炎症标志物联合感染相关器官功能衰竭评分（SOFA）对脓毒症患者早期诊断及预后评估的价值。
采用前瞻性诊断试验研究，对患者进行连续观察。根据ACCP/SCCM共识会议定义，将患者分为5组，包括非全身炎症反应综合征（SIRS）（对照组）、SIRS组、脓毒症组、严重脓毒症组和脓毒性休克组。于24小时时测定炎症指标、SOFA及PCT浓度，并分析其相关性。
共纳入208例患者，其中非SIRS组59例，SIRS组57例，脓毒症组52例，严重脓毒症组28例，脓毒性休克组12例。PCT浓度与脓毒症严重程度呈正相关，Spearman相关系数为0.909（P = 0.000）。根据受试者工作特征曲线（ROC曲线）分析原理绘制ROC曲线并计算曲线下面积（AUC）。在脓毒症诊断中，PCT的AUC值为0.936±0.020，SOFA的AUC值为0.973±0.011（均P = 0.000）。脓毒症诊断的最佳截断值，PCT为0.375μg/L，SOFA评分为3.5。PCT和SOFA评分的约登指数分别为0.808和0.801。二元Logistic回归分析证实，在排除年龄、C反应蛋白（CRP）等混杂因素后，PCT和SOFA评分与脓毒症高度相关（OR分别为84.794、10.761，均P = 0.000）。PCT和SOFA评分可用于预测脓毒症的发生率。SOFA评分是脓毒症最佳的预后指标（OR = 2.084，P = 0.0002）。
传统炎症标志物及CRP是区分SIRS与非SIRS的有用参数，但不是脓毒症患者早期诊断的可靠指标。PCT是早期诊断脓毒症以区别于SIRS的更特异指标。PCT联合SOFA评分可用于预测脓毒症的发生率。SOFA评分可根据PCT水平客观界定脓毒症的严重程度，有助于评估脓毒症患者的预后。
