Division of Microbiology, Department of Pathology, School of Medicine, The Johns Hopkins University, Baltimore, MD 21224, USA
Diagn Microbiol Infect Dis. 2012 Jul;73(3):221-7. doi: 10.1016/j.diagmicrobio.2012.05.002.
Sepsis and severe sepsis cause significant morbidity and mortality among populations worldwide; the rapid diagnosis poses a considerable challenge to physicians in acute care settings. An ideal biomarker should allow, with high diagnostic accuracy, for an early and rapid recognition of sepsis. Procalcitonin (PCT) is a recently rediscovered biomarker that fulfills many of these requirements, especially in comparison to "older" and commonly used biomarkers, and that has demonstrated superior diagnostic accuracy for a variety of infections, including sepsis. While blood cultures are still considered the "gold standard" for the diagnosis of bacteremia and sepsis, and are perhaps one of the most important functions of the clinical microbiology laboratory, PCT provides important information in early stages of sepsis as well as during antimicrobial treatment. In fact, PCT can be useful for antimicrobial stewardship and its utilization may safely lead to significant reduction of unnecessary antimicrobial therapy. However, PCT is also less than a universal and perfect biomarker, as it can also be increased in noninfectious disease conditions. Laboratories and clinicians must appreciate the complexity of diagnostic algorithms for sepsis and understand the particular information that biomarkers, such as PCT, can offer. In that context, it is necessary to not only recognize the importance of critical clinical awareness and thorough physical patient examination, but also to understand traditional microbiological methods and the need for highly sensitive biomarker assays in order to facilitate an early diagnosis and goal-directed therapy in patients suspected of sepsis. This review is intended to provide additional information for clinicians and microbiologists to better understand the physiology and diagnostic utility of procalcitonin for sepsis and other infectious disease conditions.
脓毒症和严重脓毒症在全球人群中导致了相当高的发病率和死亡率；快速诊断对急性护理环境中的医生构成了相当大的挑战。理想的生物标志物应该具有较高的诊断准确性，能够早期快速识别脓毒症。降钙素原 (PCT) 是一种最近重新发现的生物标志物，它满足了许多这些要求，特别是与“较旧”和常用的生物标志物相比，并且在各种感染（包括脓毒症）的诊断准确性方面表现出优越性。虽然血培养仍然被认为是菌血症和脓毒症诊断的“金标准”，并且可能是临床微生物学实验室最重要的功能之一，但 PCT 在脓毒症的早期以及在抗菌治疗期间提供了重要信息。事实上，PCT 对抗菌药物管理很有用，其使用可能会安全地显著减少不必要的抗菌治疗。然而，PCT 也不是一个普遍而完美的生物标志物，因为它也可以在非传染性疾病中增加。实验室和临床医生必须认识到脓毒症诊断算法的复杂性，并了解 PCT 等生物标志物可以提供的特定信息。在这种情况下，不仅需要认识到批判性临床意识和彻底的身体检查的重要性，还需要了解传统的微生物学方法和对高灵敏度生物标志物检测的需求，以便为疑似脓毒症患者的早期诊断和靶向治疗提供便利。这篇综述旨在为临床医生和微生物学家提供更多信息，以更好地理解降钙素原在脓毒症和其他感染性疾病中的生理学和诊断效用。
