Emergency Medicine Department, Sapienza University, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2013 Feb;17 Suppl 1:133-42.
To evaluate the diagnostic and prognostic usefulness of procalcitonin (PCT) in patients admitted to the Emergency Department (ED) with signs of infections and to assess the prognostic value of repeated measurements in predicting hospital mortality.
A prospective, observational study was conducted in our 400-bed General Teaching Hospital. 261 patients arriving in ED with signs/symptoms of infection were enrolled. PCT was performed upon arrival in the ED (T0), and 5 days after antibiotic therapy (T5). Blood cultures were performed in all patients upon arrival in the ED.
Mean T0 PCT value was 7.1±17.9 ng/ml, and at T5 3±9.1 ng/ml (p < 0.0001). Mean PCT in septic non-survivors was increased at T5 compared to T0 but not significantly. The PCT increase at T5 was an independent factor of mortality (OR = 1.29, p < 0.02) in septic patients. Compared to baseline mean delta % PCT decrease at T5 was 28%. Patients with a decrease delta % PCT > 28% showed a lower number of deaths, with a statistical significant difference if compared to those patients with a < 28% decrease (p < 0.004). ROC curve of delta % PCT for prediction of death has an AUC = 0.82 (p < 0.03).
PCT is a useful marker for diagnosis of systemic and local infections, and for prognostic stratification in patients with acute infectious diseases at their arrival in ED. PCT variations after antibiotic therapy are highly predictive for in-hospital mortality. PCT normalization during antibiotic therapy suggests a good response to infection possibly leading to less infection-related deaths.
评估降钙素原（PCT）在因感染症状而就诊于急诊（ED）的患者中的诊断和预后价值，并评估重复测量在预测医院死亡率方面的预后价值。
在我们的 400 张病床的综合教学医院进行了一项前瞻性、观察性研究。共纳入 261 名因感染症状/体征而就诊于 ED 的患者。在 ED 就诊时（T0）和抗生素治疗后 5 天（T5）进行 PCT 检测。所有患者在 ED 就诊时均进行血培养。
T0 时 PCT 的平均浓度为 7.1±17.9ng/ml，而在 T5 时为 3±9.1ng/ml（p<0.0001）。与 T0 相比，感染性休克非幸存者在 T5 时的 PCT 值升高，但无统计学意义。T5 时 PCT 的增加是感染性休克患者死亡的独立因素（OR=1.29，p<0.02）。与基线相比，T5 时的 delta % PCT 平均降低率为 28%。delta % PCT 降低率>28%的患者死亡率较低，与 delta % PCT 降低率<28%的患者相比差异有统计学意义（p<0.004）。delta % PCT 预测死亡的 ROC 曲线 AUC 值为 0.82（p<0.03）。
PCT 是诊断全身和局部感染以及对急性感染性疾病患者进行预后分层的有用标志物。抗生素治疗后 PCT 的变化对住院死亡率具有高度预测性。抗生素治疗期间 PCT 正常化提示对感染的反应良好，可能导致与感染相关的死亡减少。
