Department of Critical Care Medicine, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan.
J Infect Chemother. 2012 Dec;18(6):891-7. doi: 10.1007/s10156-012-0435-2. Epub 2012 Jun 13.
The clinical usefulness of presepsin for discriminating between bacterial and nonbacterial infections (including systemic inflammatory response syndrome) was studied and compared with procalcitonin (PCT) and interleukin-6 (IL-6) in a multicenter prospective study. Suspected sepsis patients (n = 207) were enrolled into the study. Presepsin levels in patients with systemic bacterial infection and localized bacterial infection were significantly higher than in those with nonbacterial infections. In addition, presepsin, PCT, and IL-6 levels in patients with bacterial infectious disease were significantly higher than in those with nonbacterial infectious disease (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). The area under the receiver operating characteristic curve was 0.908 for presepsin, 0.905 for PCT, and 0.825 for IL-6 in patients with bacterial infectious disease and those with nonbacterial infectious disease. The cutoff value of presepsin for discrimination of bacterial and nonbacterial infectious diseases was determined to be 600 pg/ml, of which the clinical sensitivity and specificity were 87.8 % and 81.4 %, respectively. Presepsin levels did not differ significantly between patients with gram-positive and gram-negative bacterial infections. The sensitivity of blood culture was 35.4 %; that for presepsin was 91.9 %. Also there were no significant differences in presepsin levels between the blood culture-positive and -negative groups. Consequently, presepsin is useful for the diagnosis of sepsis, and it is superior to conventional markers and blood culture.
在一项多中心前瞻性研究中，研究了并比较了降钙素原（PCT）和白细胞介素-6（IL-6），以评估其对鉴别细菌和非细菌性感染（包括全身炎症反应综合征）的临床应用价值。纳入疑似脓毒症患者（n=207）。全身性细菌感染和局部性细菌感染患者的降钙素原水平明显高于非细菌性感染患者。此外，细菌性感染患者的降钙素原、PCT 和 IL-6 水平明显高于非细菌性感染患者（P<0.0001，P<0.0001 和 P<0.0001）。降钙素原、PCT 和 IL-6 鉴别细菌性和非细菌性感染的受试者工作特征曲线下面积分别为 0.908、0.905 和 0.825。降钙素原区分细菌性和非细菌性感染的截断值为 600pg/ml，其临床敏感性和特异性分别为 87.8%和 81.4%。降钙素原水平在革兰阳性菌和革兰阴性菌感染患者之间无显著差异。血培养的敏感性为 35.4%；降钙素原的敏感性为 91.9%。血培养阳性组和阴性组之间的降钙素原水平也无显著差异。因此，降钙素原有助于脓毒症的诊断，且优于常规标志物和血培养。
