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降钙素原水平预测社区获得性肺炎患者的菌血症:一项前瞻性队列研究。

Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial.

机构信息

Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland.

出版信息

Chest. 2010 Jul;138(1):121-9. doi: 10.1378/chest.09-2920. Epub 2010 Mar 18.

Abstract

BACKGROUND

Guidelines recommend blood culture sampling from hospitalized patients with suspected community-acquired pneumonia (CAP). However, the yield of true-positive results is low. We investigated the benefit of procalcitonin (PCT) on hospital admission to predict blood culture positivity in CAP.

METHODS

This was a prospective cohort study with a derivation and validation set including 925 patients with CAP who underwent blood culture sampling on hospital admission.

RESULTS

A total of 73 (7.9%) patients had true bacteremia (43 of 463 in the derivation cohort, 30 of 462 in the validation cohort). The area under the receiver operating characteristics curve of PCT in the derivation and validation cohorts was similar (derivation cohort, 0.83; 95% CI, 0.78-0.89; validation cohort, 0.79; 95% CI, 0.72-0.88). Overall, PCT was a significantly better predictor for blood culture positivity than WBC count, C-reactive protein, and other clinical parameters. In multivariate regression analysis, only antibiotic pretreatment (adjusted odds ratio, 0.25; P < .05) and PCT serum levels (adjusted odds ratio, 3.72; P < .001) were independent predictors. Overall, a PCT cutoff of 0.1 microg/L would enable reduction of the total number of blood cultures by 12.6% and still identify 99% of the positive blood cultures. Similarly, 0.25 microg/L and 0.5 microg/L cutoffs would enable reduction of blood cultures by 37% and 52%, respectively, and still identify 96% and 88%, respectively, of positive blood cultures.

CONCLUSIONS

Initial PCT level accurately predicted blood culture positivity in patients with CAP. PCT measurement has the potential to reduce the number of drawn blood cultures in the emergency department and to implement a more targeted allocation of limited health-care resources.

摘要

背景

指南建议对疑似社区获得性肺炎(CAP)的住院患者进行血培养采样。然而,真正的阳性结果产量较低。我们研究了降钙素原(PCT)对入院时预测 CAP 血培养阳性的益处。

方法

这是一项前瞻性队列研究,包括 925 名接受入院时血培养采样的 CAP 患者,其中包括一个推导队列和一个验证队列。

结果

共有 73 名(7.9%)患者存在真菌血症(推导队列 463 例中 43 例,验证队列 462 例中 30 例)。PCT 在推导和验证队列中的受试者工作特征曲线下面积相似(推导队列,0.83;95%置信区间,0.78-0.89;验证队列,0.79;95%置信区间,0.72-0.88)。总体而言,PCT 是血培养阳性的显著更好的预测指标,优于白细胞计数、C 反应蛋白和其他临床参数。在多变量回归分析中,只有抗生素预处理(调整优势比,0.25;P <.05)和 PCT 血清水平(调整优势比,3.72;P <.001)是独立的预测指标。总体而言,PCT 截断值为 0.1μg/L 可将血培养总数减少 12.6%,仍可识别 99%的阳性血培养。同样,0.25μg/L 和 0.5μg/L 截断值可分别减少 37%和 52%的血培养,仍可分别识别 96%和 88%的阳性血培养。

结论

初始 PCT 水平准确预测了 CAP 患者的血培养阳性。PCT 测量有可能减少急诊科抽取的血培养数量,并实施更有针对性的分配有限的卫生保健资源。

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