Uusitalo-Seppälä Raija, Koskinen Pertti, Leino Aila, Peuravuori Heikki, Vahlberg Tero, Rintala Esa M
Department of Infectious Diseases, Satakunta Central Hospital, Pori, Finland.
Scand J Infect Dis. 2011 Dec;43(11-12):883-90. doi: 10.3109/00365548.2011.600325. Epub 2011 Sep 6.
To determine the diagnostic values of plasma C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) using an electrochemiluminescence immunoassay (ECLIA) method (Roche Diagnostics GmbH, Mannheim, Germany) to identify severe sepsis in an emergency room (ER) setting.
This was a single-centre prospective follow-up study of 539 consecutive adult patients admitted to the ER with suspected infection. Blood samples were taken concurrently with blood cultures at admission. Patients were divided into 5 groups on the basis of systemic inflammatory response syndrome (SIRS) criteria, documentation of bacterial infection, and organ dysfunction. Fifty-nine patients with no SIRS or bacterial infection, 68 patients with bacterial infection but no SIRS, 54 patients with SIRS but no bacterial infection, 309 patients with sepsis (SIRS and bacterial infection), and 49 patients with severe sepsis (sepsis and organ failure) were evaluated.
In a logistic regression model, the odds ratio (OR) for PCT was 1.58 (95% confidence interval (CI) 1.37-1.82, p < 0.0001), for IL-6 was 1.54 (95% CI 1.32-1.80, p < 0.0001), and for CRP was 1.33 (95% CI 1.01-1.75, p = 0.045). The area under the curve (AUC) was 0.77 (95% CI 0.71-0.84) for PCT, 0.72 (95% CI 0.64-0.80) for IL-6, and 0.60 (95% CI 0.51-0.69) for CRP. PCT emerged as the best marker for severe sepsis, but the difference in AUC was not significant between PCT and IL-6. In multivariate logistic regression analysis, after adjusting for confounders, PCT and IL-6 remained significant independent predictors of severe sepsis.
PCT and IL-6 proved superior to CRP in detecting patients with severe sepsis. The findings thus support the use of either PCT or IL-6 as an early tool to diagnose severe sepsis. The automatic ECLIA method allows even night-shift measurements.
采用电化学发光免疫分析法（ECLIA法，德国曼海姆罗氏诊断有限公司）测定血浆C反应蛋白（CRP）、降钙素原（PCT）和白细胞介素-6（IL-6），以确定其在急诊室环境中识别严重脓毒症的诊断价值。
这是一项单中心前瞻性随访研究，对539例因疑似感染入住急诊室的成年连续患者进行研究。入院时同时采集血样和进行血培养。根据全身炎症反应综合征（SIRS）标准、细菌感染记录和器官功能障碍将患者分为5组。对59例无SIRS或细菌感染的患者、68例有细菌感染但无SIRS的患者、54例有SIRS但无细菌感染的患者、309例脓毒症患者（SIRS和细菌感染）和49例严重脓毒症患者（脓毒症和器官衰竭）进行评估。
在逻辑回归模型中，PCT的比值比（OR）为1.58（95%置信区间[CI]1.37 - 1.82，p < 0.0001），IL-6的OR为1.54（95%CI 1.32 - 1.80，p < 0.0001），CRP的OR为1.33（95%CI 1.01 - 1.75，p = 0.045）。PCT的曲线下面积（AUC）为0.77（95%CI 0.71 - 0.84），IL-6的AUC为0.72（95%CI 0.64 - 0.80），CRP的AUC为0.60（95%CI 0.51 - 0.69）。PCT成为严重脓毒症的最佳标志物，但PCT和IL-6之间的AUC差异不显著。在多因素逻辑回归分析中，调整混杂因素后，PCT和IL-6仍然是严重脓毒症的显著独立预测因子。
PCT和IL-6在检测严重脓毒症患者方面优于CRP。因此，这些发现支持使用PCT或IL-6作为诊断严重脓毒症的早期工具。自动ECLIA法甚至允许进行夜班测量。
