Azevedo José Raimundo Araujo de, Torres Orlando Jorge Martins, Czeczko Nicolau Gregori, Tuon Felipe Francisco, Nassif Paulo Afonso Nunes, Souza Gleim Dias de
Intensive Care Unit, Santo Domingo Hospital, São Luis, Maranhão State – MA, Brazil.
Rev Col Bras Cir. 2012 Dec;39(6):456-61. doi: 10.1590/s0100-69912012000600003.
To evaluate the tendency of the plasma concentration and clearance of procalcitonin (PCT-c) as biomarkers of prognosis of patients with severe sepsis and septic shock, compared to another early prognosis marker, the number of SIRS criteria at sepsis diagnosis.
We conducted a prospective, observational, cohort study, with patients with severe sepsis and septic shock. The serum procalcitonin was determined at diagnosis of sepsis and after 24 and 48 hours. Demographic data, APACHE IV, SOFA score on arrival, number of SIRS criteria at diagnosis, site of infection and microbiological results were recorded.
Twenty-eight patients were included, 19 clinical and nine surgical. In 13 (46.4%) the source of sepsis was pulmonary, abdominal in seven (25.0%), urinary in five (17.9%) and soft tissue in three cases (10.7%). Fifteen patients had severe sepsis and 13 septic shock. Overall mortality was 17.9% (five patients), three with septic shock. Twenty-eight PCT determinations were performed at sepsis diagnosis, 27 after 24 hours and 26 after 48 hours. The initial concentration was not significantly different between survivors and non-survivors groups, but the differences between the two groups after 24 and 48 hours were statistically significant. There was no difference in the number of SIRS criteria. The 24-hour procalcitonin clearance proved to be significantly higher in the group of survivors (-3.0 versus -300.0, p = 0.028). Although the 48-hour procalcitonin clearance has shown to be higher in the group of survivors when compared to non-survivors, the difference did not reach statistical significance.
Persistently high procalcitonin concentrations in plasma, as well as reduced 24-hours PCT clearence, were associated with a significant increase in mortality in patients with severe sepsis and septic shock.
与另一种早期预后标志物——脓毒症诊断时的全身炎症反应综合征（SIRS）标准数量相比，评估降钙素原（PCT-c）的血浆浓度和清除率作为严重脓毒症和脓毒性休克患者预后生物标志物的变化趋势。
我们对严重脓毒症和脓毒性休克患者进行了一项前瞻性、观察性队列研究。在脓毒症诊断时以及诊断后24小时和48小时测定血清降钙素原。记录人口统计学数据、急性生理与慢性健康状况评分系统（APACHE IV）、入院时的序贯器官衰竭评估（SOFA）评分、诊断时的SIRS标准数量、感染部位和微生物学结果。
纳入28例患者，其中19例为内科患者，9例为外科患者。13例（46.4%）脓毒症来源为肺部，7例（25.0%）为腹部，5例（17.9%）为泌尿系统，3例（10.7%）为软组织。15例患者为严重脓毒症，13例为脓毒性休克。总死亡率为17.9%（5例患者），3例死于脓毒性休克。在脓毒症诊断时进行了28次降钙素原测定，24小时后进行了27次，48小时后进行了26次。幸存者和非幸存者组的初始浓度无显著差异，但24小时和48小时后两组之间的差异具有统计学意义。SIRS标准数量无差异。24小时降钙素原清除率在幸存者组中明显更高（-3.0对-300.0，p = 0.028）。尽管与非幸存者相比，48小时降钙素原清除率在幸存者组中更高，但差异未达到统计学意义。
严重脓毒症和脓毒性休克患者血浆中降钙素原浓度持续升高以及24小时降钙素原清除率降低与死亡率显著增加相关。
