降钙素原是社区获得性肺炎所致急性呼吸窘迫综合征中一种有价值的预后标志物。

Procalcitonin is a valuable prognostic marker in ARDS caused by community-acquired pneumonia.

作者信息

Tseng Jeng-Sen, Chan Ming-Cheng, Hsu Jeng-Yuan, Kuo Benjamin Ing-Tiau, Wu Chieh-Liang

机构信息

Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.

出版信息

Respirology. 2008 Jun;13(4):505-9. doi: 10.1111/j.1440-1843.2008.01293.x. Epub 2008 Apr 14.

DOI:10.1111/j.1440-1843.2008.01293.x

PMID:18422867

Abstract

BACKGROUND AND OBJECTIVE

ARDS is life-threatening acute respiratory failure, and pneumonia is one of the most common causes of direct ARDS. Procalcitonin (PCT) has been evaluated for its utility in determining the aetiology of community-acquired pneumonia (CAP), choice of antibiotics and prediction of outcome. This study evaluated the role of PCT in predicting the outcome of patients with ARDS caused by severe CAP.

METHODS

This was a prospective observational study conducted from September 2002 to December 2003. The plasma PCT was analysed at baseline, 24 and 72 h after enrolment and measured by ELISA.

RESULTS

Of the 22 patients with ARDS caused by CAP and enrolled in the study, 17 (77.3%) were alive 14 days after admission and five (22.7%) had died. The survivors had lower APACHE II scores (22.2 +/- 4.6 vs 30.6 +/- 9.6, P = 0.031), pneumonia severity index (141.9 +/- 2.2 vs 195.6 +/- 23.8, P = 0.005) and lower plasma PCT at baseline (9.83 +/- 3.54 vs 106.70 +/- 67.86, P = 0.004), at 24 h (10.51 +/- 5.39 vs 81.32 +/- 57.68, P = 0.014) and at 72 h (2.03 +/- 0.76 vs 19.57 +/- 6.67, P = 0.005).

CONCLUSION

PCT analysed within 72 h of the onset of ARDS predicted mortality of patients with ARDS caused by severe CAP.

摘要

背景与目的

急性呼吸窘迫综合征（ARDS）是危及生命的急性呼吸衰竭，肺炎是直接导致ARDS的最常见原因之一。降钙素原（PCT）已被评估用于确定社区获得性肺炎（CAP）的病因、抗生素的选择及预后预测。本研究评估PCT在预测重症CAP所致ARDS患者预后中的作用。

方法

这是一项于2002年9月至2003年12月进行的前瞻性观察性研究。在基线、入组后24小时和72小时分析血浆PCT，采用酶联免疫吸附测定法（ELISA）进行检测。

结果

本研究纳入了22例由CAP导致ARDS的患者，其中17例（77.3%）在入院14天后存活，5例（22.7%）死亡。存活者的急性生理与慢性健康状况评分系统II（APACHE II）评分较低（22.2±4.6对30.6±9.6，P = 0.031），肺炎严重程度指数较低（141.9±2.2对195.6±23.8，P = 0.005），且基线时血浆PCT较低（9.83±3.54对106.70±67.86，P = 0.004），24小时时（10.51±5.39对81.32±57.68，P = 0.014）以及72小时时（2.03±0.76对19.57±6.67，P = 0.005）。