Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University in Prague and University Hospital Bulovka, Budínova 2, Prague 8, Czech Republic.
Infection. 2011 Oct;39(5):411-7. doi: 10.1007/s15010-011-0126-4. Epub 2011 Jul 1.
Timely knowledge of the bacterial etiology and localization of infection are important for empirical antibiotic therapy. Thus, the goal of this study was to evaluate routinely used biomarkers together with novel laboratory parameters in the diagnosis of infection.
In this prospective study, 54 adult patients with bacterial infections admitted to the Department of Infectious Diseases were included. For comparison, 27 patients with viral infections were enrolled. In these patients, white blood cell (WBC) counts, differential blood counts, serum levels of procalcitonin (PCT), IL-1β, IL-6, IL-8, IL-10, IL-12, TNF-α, IFN-γ, soluble CD14 (sCD14), heparin-binding protein (HBP), cortisol (Cort), and monocyte surface expression of TLR2, TLR4, HLA-DR, and CD14 were analyzed. Also, these biomarkers were evaluated in 21 patients with acute community-acquired bacterial pneumonia (CABP), as well as in 21 patients with pyelonephritis and urosepsis.
The highest sensitivity and specificity (expressed as the area under the curve [AUC]) for bacterial infection were observed in serum concentration of PCT (0.952), neutrophil and lymphocyte counts (0.852 and 0.841, respectively), and serum levels of HBP (0.837), IL-6 (0.830), and Cort (0.817). In addition, the serum levels of IFN-γ and Cort were significantly higher and IL-8 levels were lower in CABP when compared to pyelonephritis or urosepsis.
From the novel potential biomarkers, only PCT demonstrated superiority over the routine parameters in the differentiation of bacterial from viral infections. However, some of the novel parameters should be further evaluated in larger and better characterized cohorts of patients in order to find their clinical applications.
及时了解细菌病因和感染部位对于经验性抗生素治疗非常重要。因此，本研究的目的是评估常规使用的生物标志物与新的实验室参数在感染诊断中的作用。
在这项前瞻性研究中，纳入了 54 名因细菌感染而入住传染病科的成年患者。为了进行比较，还纳入了 27 名患有病毒感染的患者。在这些患者中，分析了白细胞（WBC）计数、白细胞分类计数、降钙素原（PCT）、IL-1β、IL-6、IL-8、IL-10、IL-12、TNF-α、IFN-γ、可溶性 CD14（sCD14）、肝素结合蛋白（HBP）、皮质醇（Cort）以及单核细胞表面 TLR2、TLR4、HLA-DR 和 CD14 的表达。此外，还评估了 21 名患有急性社区获得性细菌性肺炎（CABP）、21 名患有肾盂肾炎和尿脓毒症的患者的这些生物标志物。
对于细菌感染，PCT 血清浓度（0.952）、中性粒细胞和淋巴细胞计数（分别为 0.852 和 0.841）以及 HBP 血清水平（0.837）、IL-6（0.830）和 Cort（0.817）的灵敏度和特异性（以曲线下面积[AUC]表示）最高。此外，与肾盂肾炎或尿脓毒症相比，CABP 患者的 IFN-γ 血清水平和 Cort 水平显著升高，而 IL-8 水平较低。
在新的潜在生物标志物中，只有 PCT 在区分细菌感染和病毒感染方面优于常规参数。然而，为了找到其临床应用，一些新的参数应该在更大、特征更明确的患者队列中进一步评估。
