Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
Am J Med. 2010 Dec;123(12):1121-7. doi: 10.1016/j.amjmed.2010.07.018. Epub 2010 Oct 1.
diagnostic delay contributes to high morbidity and mortality in infective endocarditis. A readily available diagnostic marker of infective endocarditis is desirable. S-procalcitonin has been proposed as a candidate, but data on its yield are conflicting. We tested its diagnostic value in a large population of patients seen in a tertiary center.
this prospective study included 759 consecutive patients referred for echocardiographic examination on clinical suspicion of infective endocarditis. Transthoracic echocardiography was followed by immediate transesophageal examination, and a blood sample was obtained for procalcitonin analysis. Infective endocarditis was diagnosed by an interdisciplinary team and confirmed according to the Duke criteria. The team was unaware of the results of procalcitonin analyses.
infective endocarditis was present in 147 patients (19%). Procalcitonin was higher in these patients than in those in whom infective endocarditis was rejected (median, 0.21 ng/mL vs. 0.13 ng/mL; P <.0005). Multivariate analysis identified significant independent determinants of high procalcitonin: blood culture with endocarditis-typical microorganisms (odds ratio [OR], 2.81), temperature ≥ 38°C (OR, 2.61), symptoms ≤ 5 days (OR, 2.39), immunocompromised status (OR, 1.74), and male gender (OR, 1.61). Tests at various procalcitonin thresholds yielded an acceptable sensitivity of 95% at 0.04 ng/mL, but specificity was only 14%. Only 12% had procalcitonin below this threshold, which might justify postponement of further examinations for infective endocarditis.
procalcitonin was significantly higher in patients with infective endocarditis than in patients without infective endocarditis and bacteremia with endocarditis-typical organisms was the strongest independent determinant of high procalcitonin. The clinical importance of this is questionable, because a suitable procalcitonin threshold for diagnosing or excluding infective endocarditis was not established.
诊断延迟导致感染性心内膜炎的发病率和死亡率居高不下。人们希望有一种易于获得的感染性心内膜炎诊断标志物。降钙素原已被提议作为候选标志物，但关于其检出率的数据存在矛盾。我们在一家三级中心的大量就诊患者中检验了它的诊断价值。
这项前瞻性研究纳入了 759 例连续就诊的患者，他们因疑似感染性心内膜炎而行超声心动图检查。先行经胸超声心动图检查，然后立即行经食管超声心动图检查，并采集血样进行降钙素原分析。感染性心内膜炎由跨学科团队诊断，并根据 Duke 标准进行确认。团队不知道降钙素原分析的结果。
147 例（19%）患者存在感染性心内膜炎。这些患者的降钙素原水平高于感染性心内膜炎被排除的患者（中位数，0.21ng/mL 比 0.13ng/mL；P<0.0005）。多变量分析确定了降钙素原升高的显著独立决定因素：血培养检出感染性心内膜炎典型微生物（比值比[OR]，2.81）、体温≥38°C（OR，2.61）、症状持续时间≤5 天（OR，2.39）、免疫功能低下（OR，1.74）和男性（OR，1.61）。在不同降钙素原阈值下进行检测，降钙素原阈值为 0.04ng/mL 时可获得 95%的可接受敏感性，但特异性仅为 14%。仅有 12%的患者降钙素原低于此阈值，这可能证明可以推迟进一步检查以排除感染性心内膜炎。
感染性心内膜炎患者的降钙素原显著高于非感染性心内膜炎患者，血培养检出感染性心内膜炎典型微生物是降钙素原升高的最强独立决定因素。但降钙素原对诊断或排除感染性心内膜炎的临床重要性值得怀疑，因为尚未确定用于诊断或排除感染性心内膜炎的合适降钙素原阈值。
