Department of Emergency Medicine, Chang-Gung Memorial Hospital, Keelung Branch, Taipei, Taiwan, ROC.
Acad Emerg Med. 2011 Feb;18(2):121-6. doi: 10.1111/j.1553-2712.2010.00991.x. Epub 2011 Jan 28.
The objective was to determine the diagnostic accuracy of procalcitonin measurement for bacterial infections in patients with all causes of liver cirrhosis.
The authors conducted a cross-sectional study of 98 patients with cirrhosis treated in the emergency department (ED) of Chang-Gung Memorial Hospital, Taiwan. Serum procalcitonin levels and other clinical information were obtained concurrently. Patients were assigned to a sepsis or nonsepsis group after the medical records were reviewed by two emergency physicians blinded to the study. Receiver operating characteristic (ROC) curve analysis was conducted to determine the sensitivity, specificity, likelihood ratio, and suggested cutoff values. The diagnostic accuracy of the C-reactive protein (CRP) level was also determined for comparison.
A total of 98 patients were enrolled for analysis in 1 year. Twenty-seven patients (27.6%) were assigned to the sepsis group. Eleven patients (11.2%) had positive blood cultures. The areas under the ROC curves for procalcitonin and CRP in predicting sepsis were 0.89 (95% confidence interval [CI] = 0.77 to 0.92) and 0.81 (95% CI = 0.72 to 0.89), respectively (p = 0.11). The cutoff that maximized Youden's index was 0.49 ng/mL for procalcitonin and 24.7 mg/L for CRP. At these cutoffs, the sensitivity and specificity were 81.5 and 87.3% for procalcitonin and 80.0 and 80.3% for CRP. These results suggest that procalcitonin measurement shows at least an equivalent diagnostic accuracy to CRP measurement.
Procalcitonin provided satisfactory diagnostic accuracy in differentiating bacterial infections in patients with all causes of liver cirrhosis in the ED. A cutoff value of 0.5 ng/mL is suggested for clinical use.
本研究旨在确定降钙素原检测在所有病因导致的肝硬化患者细菌感染中的诊断准确性。
本研究为横断面研究，共纳入台湾长庚纪念医院急诊科（ED）治疗的 98 例肝硬化患者。同时获得血清降钙素原水平和其他临床信息。两名急诊医师在不了解研究的情况下对病历进行回顾，将患者分为脓毒症或非脓毒症组。通过受试者工作特征（ROC）曲线分析，确定灵敏度、特异性、似然比和建议的截断值。还确定了 C 反应蛋白（CRP）水平的诊断准确性，以进行比较。
共纳入 98 例患者进行了 1 年分析。27 例（27.6%）患者被分到脓毒症组。11 例（11.2%）患者血培养阳性。降钙素原和 CRP 预测脓毒症的 ROC 曲线下面积分别为 0.89（95%置信区间 [CI] = 0.77 至 0.92）和 0.81（95% CI = 0.72 至 0.89）（p = 0.11）。最大化 Youden 指数的截断值分别为降钙素原 0.49 ng/mL 和 CRP 24.7 mg/L。在此截断值下，降钙素原的灵敏度和特异性分别为 81.5%和 87.3%，CRP 分别为 80.0%和 80.3%。这些结果表明，降钙素原检测在区分 ED 中所有病因导致的肝硬化患者的细菌感染方面具有至少相当的诊断准确性。建议临床使用 0.5 ng/mL 的截断值。
降钙素原在区分 ED 中所有病因导致的肝硬化患者的细菌感染方面具有令人满意的诊断准确性。建议临床使用 0.5 ng/mL 的截断值。
