Mori Yasuo, Miyawaki Kohta, Kato Koji, Takenaka Katsuto, Iwasaki Hiromi, Harada Naoki, Miyamoto Toshihiro, Akashi Koichi, Teshima Takanori
Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Japan.
Intern Med. 2011;50(19):2149-55. doi: 10.2169/internalmedicine.50.5798. Epub 2011 Oct 1.
Procalcitonin (PCT) has been increasingly used as a biomarker of infection. The purpose of this study was to evaluate its diagnostic value after hematopoietic stem cell transplantation (HSCT), where non-infectious febrile complications such as graft-versus-host disease frequently develop.
We retrospectively analyzed 144 febrile episodes (infections: 82, and noninfections: 62) in adult patients with hematological disorders, including 57 and 87 episodes in HSCT and non-HSCT patients, respectively.
Of 57 febrile episodes in HSCT patients, 46 (86%) and 25 (44%) revealed positivity for C-reactive protein (CRP) and PCT, respectively. Among 87 febrile episodes in non-HSCT patients, 81 (93%) and 22 (25%) events showed positive results of CRP and PCT. Both of these biomarkers were associated with infectious episodes in univariate analysis. Multivariate analysis showed that a high cut-off level (>9.5 mg/dL) of CRP was a better indicator for infections than PCT in HSCT patients, while PCT positivity was more diagnostic for infections than any cutoff CRP level in non-HSCT patients.
It may be necessary to interpret the results of these biomarkers with different orders of priority in transplant versus nontransplant patients.
降钙素原（PCT）已越来越多地用作感染的生物标志物。本研究的目的是评估其在造血干细胞移植（HSCT）后的诊断价值，在HSCT中经常会出现移植物抗宿主病等非感染性发热并发症。
我们回顾性分析了144例血液系统疾病成年患者的发热事件（感染：82例，非感染：62例），其中HSCT患者和非HSCT患者分别有57例和87例发热事件。
在HSCT患者的57例发热事件中，C反应蛋白（CRP）和PCT阳性分别为46例（86%）和25例（44%）。在非HSCT患者的87例发热事件中，81例（93%）和22例（25%）的CRP和PCT检测结果呈阳性。在单因素分析中，这两种生物标志物均与感染性事件相关。多因素分析显示，在HSCT患者中，CRP的高临界值水平（>9.5mg/dL）比PCT更能作为感染的指标，而在非HSCT患者中，PCT阳性比任何CRP临界值水平对感染更具诊断价值。
对于移植患者和非移植患者，可能有必要以不同的优先顺序来解读这些生物标志物的结果。
