Biochemistry laboratory, University Hospital of the Canary Islands, Tenerife, Spain.
Eur Cytokine Netw. 2010 Mar;21(1):19-26. doi: 10.1684/ecn.2009.0185.
Procalcitonin is useful for the diagnosis of sepsis, but its prognostic value regarding mortality is unclear. Our objective was to determine the prognostic value of procalcitonin determined at the onset of sepsis, and to compare it with other markers of inflammatory response, malnutrition and organ dysfunction data.
We studied 253 hospitalized patients (146 men, 107 women) with a median age of 65 years. Sepsis was defined as infection, and at least two SIRS criteria. We assessed co-morbidities, nutritional status, bacteremia, procalcitonin and other inflammatory markers (PCR, TNF-alpha, IL6, TREM-1, IL-10, IL-1ra, CD14 and LBP), and organ function using the SOFA score. Mortality was assessed at 28 days after onset of sepsis.
At day 28, 49 (19%) patients had died. Inflammatory markers showed only moderate predictive value for mortality, with IL-10 and IL-6 being the best predictors. Mortality was mainly related to organ dysfunction indicators (SOFA and Glasgow scores), serum lactate, ferritin and LDH levels, and to nutritional data such as subjective assessment, handgrip strength and serum transferrin levels. The most frequent location of sepsis was the lung, with 140 cases (55%), which showed more comorbidity, worse nutritional status, less frequent bacteremia and lower inflammatory response. When the analysis was limited to patients with non-pulmonary sepsis, organ dysfunction, nutritional status and inflammatory markers showed the best prognostic value. Of the inflammatory markers, procalcitonin showed only moderate predictive value; however it showed the highest correlation with bacteremia and the ability to discriminate non-complicated sepsis from severe forms.
Procalcitonin only showed moderate predictive value for sepsis-related mortality, being surpassed by organ dysfunction, nutritional status, IL-10 and IL-6. However, it proved useful to discriminate between non-complicated and severe forms of sepsis.
降钙素原（PCT）对脓毒症的诊断具有一定价值，但关于其预后价值（死亡率）尚不清楚。本研究旨在明确脓毒症发病时 PCT 的预后价值，并与其他炎症反应标志物、营养不良和器官功能障碍数据进行比较。
我们研究了 253 名住院患者（146 名男性，107 名女性），中位年龄 65 岁。脓毒症定义为感染，且至少存在 2 个全身炎症反应综合征（SIRS）标准。我们评估了合并症、营养状况、菌血症、PCT 和其他炎症标志物（PCR、TNF-α、IL6、TREM-1、IL-10、IL-1ra、CD14 和 LBP），以及使用 SOFA 评分评估器官功能。在脓毒症发病后 28 天评估死亡率。
在第 28 天，49 名（19%）患者死亡。炎症标志物对死亡率的预测价值仅为中度，其中 IL-10 和 IL-6 是最佳预测指标。死亡率主要与器官功能障碍指标（SOFA 和格拉斯哥评分）、血清乳酸、铁蛋白和 LDH 水平以及营养数据（如主观评估、手握力和血清转铁蛋白水平）相关。脓毒症最常见的部位是肺部，共 140 例（55%），这些患者合并症更多、营养状况更差、菌血症发生率更低、炎症反应更弱。当分析仅限于非肺部脓毒症患者时，器官功能障碍、营养状况和炎症标志物显示出最佳的预后价值。在炎症标志物中，PCT 仅具有中度预测价值，但它与菌血症具有最高的相关性，能够区分非复杂性脓毒症和严重形式。
PCT 对脓毒症相关死亡率的预测价值仅为中度，其预测价值逊于器官功能障碍、营养状况、IL-10 和 IL-6。然而，它在区分非复杂性和严重形式的脓毒症方面是有用的。
