Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
J Infect. 2012 May;64(5):484-93. doi: 10.1016/j.jinf.2012.01.002. Epub 2012 Jan 8.
Fever suggests the presence of microbial infection in critically ill patients. The aim was to compare the role of old and new biomarkers in predicting absence or presence of microbial infection, its invasiveness and severity in critically ill patients with new onset fever.
We prospectively studied 101 patients in the intensive care unit with new onset fever (>38.3 °C). Routine infection parameters, lactate, procalcitonin (PCT), midregional pro-adrenomedullin (MR proADM), midregional pro-atrial natriuretic peptide (MR proANP) and copeptin (COP) were measured daily for three days after inclusion. Likelihood, invasiveness (by bloodstream infection, BSI) and severity of microbial infection were assessed by cultures, imaging techniques and clinical courses.
All patients had systemic inflammatory response syndrome; 45% had a probable or proven local infection and 12% a BSI, with 20 and 33% mortality in the ICU, respectively. Only peak PCT (cutoff 0.65 ng/mL at minimum) was of predictive value for all endpoints studied, i.e. BSI, septic shock and mortality (high risk infection) and infection without BSI, shock and mortality (low risk infection), at areas under the receiver operating characteristic curves varying between 0.67 (P = 0.003) and 0.72 (P < 0.001). In multivariable analysis, the combination of C-reactive protein and lactate best predicted high risk infection, followed by PCT. For low risk infection, PCT was the single best predictor.
In critically ill patients with new onset fever, plasma PCT as a single variable, among old and new biomarkers, best helps, to some extent, to predict ICU-acquired, high risk microbial infection when peaking above 0.65 ng/mL and low risk infection when peaking below 0.65 ng/mL.
发热提示危重症患者存在微生物感染。本研究旨在比较新旧生物标志物在预测新发发热危重症患者微生物感染、感染侵袭性和严重程度方面的作用。
我们前瞻性研究了 101 例新发热（>38.3°C）的重症监护病房患者。入组后 3 天内每天检测常规感染参数、乳酸、降钙素原（PCT）、中区域促肾上腺皮质激素（MR proADM）、中区域心房利钠肽（MR proANP）和 copeptin（COP）。通过培养、影像学技术和临床病程评估微生物感染的可能性、侵袭性（血流感染，BSI）和严重程度。
所有患者均有全身炎症反应综合征；45%的患者有局部感染的可能性或证据，12%的患者有 BSI，ICU 的死亡率分别为 20%和 33%。只有 PCT 峰值（最小 0.65ng/mL 时的截断值）对所有研究终点（BSI、感染性休克和死亡率（高风险感染）和无 BSI、感染性休克和死亡率（低风险感染））具有预测价值，曲线下面积（AUC）在 0.67（P = 0.003）至 0.72（P < 0.001）之间。多变量分析显示，C 反应蛋白和乳酸联合可最佳预测高风险感染，其次是 PCT。对于低风险感染，PCT 是唯一的最佳预测指标。
在新发发热的危重症患者中，血浆 PCT 作为单一变量，在新旧生物标志物中，在达到 0.65ng/mL 以上时有助于一定程度地预测 ICU 获得的高风险微生物感染，在达到 0.65ng/mL 以下时有助于预测低风险感染。
