Second Critical Care Department, Attiko University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Minerva Anestesiol. 2012 Jul;78(7):823-35. Epub 2012 May 4.
Procalcitonin (PCT) has emerged as the most specific biomarker for bacterial infection. As clinicians become more familiar with its use, a multitude of observational studies have reported on its diagnostic potential in distinct types of infections and various clinical situations, such as in neutropenia or in the postoperative period. In the Intensive Care Unit setting, however, the prognostic value of a single PCT measurement at the time of admission on a patient with sepsis is suboptimal. Especially in cases of community-acquired pneumonia, cardiovascular biomarkers, such as mid-regional proadrenomedullin, seem to carry stronger prognostic potential than PCT. Nevertheless, the study of PCT kinetics may still be of use as a risk assessment tool for the general population of critically ill patients with sepsis syndrome. The most recent significant development in the field of PCT monitoring, is the publication of several randomized controlled trials that investigated its use as a decision making tool for the initiation and/or the duration of antibiotic treatment. Currently, the available evidence suggests that the incorporation of PCT measurements to assist with the duration of antibiotic stewardship programs may decrease antibiotic use without compromising clinical outcomes. Nevertheless, this strategy still needs further validation in large prospective studies.
降钙素原 (PCT) 已成为细菌感染最特异的生物标志物。随着临床医生对其应用的逐渐熟悉，大量观察性研究报告了其在不同类型感染和各种临床情况下的诊断潜力，如中性粒细胞减少症或术后期间。然而，在重症监护病房 (ICU) 环境中，在脓毒症患者入院时单次 PCT 测量的预后价值并不理想。特别是在社区获得性肺炎的情况下，心血管生物标志物，如中区域前肾上腺髓质素，似乎比 PCT 具有更强的预后潜力。然而，研究 PCT 动力学仍然可以作为脓毒症综合征危重病患者的一般人群的风险评估工具。在 PCT 监测领域的最新重要进展是发表了几项随机对照试验，研究了 PCT 在启动和/或抗生素治疗持续时间方面的决策工具的用途。目前，现有证据表明，将 PCT 测量值纳入辅助抗生素管理计划的持续时间可能会减少抗生素的使用，而不会影响临床结果。然而，这一策略仍需要在大型前瞻性研究中进一步验证。
