aEmergency Services Institute bDepartment of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland cDepartment of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio dDepartment of General Surgery, The Johns Hopkins Hospital eDepartment of Pathology, Clinical Chemistry Laboratories, University of Maryland Medical Center, Baltimore, Maryland fSection of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
Eur J Emerg Med. 2014 Apr;21(2):112-7. doi: 10.1097/MEJ.0b013e328361fee2.
In the critical care setting, increasing levels of midregional proadrenomedullin (MRproADM), midregional proatrial natriuretic peptide (MRproANP), procalcitonin (PCT), copeptin, and proendothelin-1 (proET-1) have been shown to be correlated with increasing severity of sepsis. The objective of this study was to investigate the utility of sepsis biomarkers in an Emergency Department (ED) population.
Through a prospective, observational pilot study, we investigated the utility of MRproADM, MRproANP, PCT, copeptin, and proET-1 in predicting a diagnosis of early sepsis in patients presenting to the ED for suspected infection. Data were analyzed using nonparametric Mann-Whitney U-tests, χ²-tests, and receiver operating characteristic curves.
Of the 66 patients enrolled in this study, 37 (56.1%) were men, with a median age of 58 years [interquartile range (IQR) 39-69 years], and 19 (28.8%) had a final diagnosis of early sepsis. A higher percentage of sepsis patients compared with no-sepsis patients met systemic inflammatory response syndrome (SIRS) criteria at initial presentation (85.7 vs. 41.3%; P<0.0001) and were admitted to the hospital (84.2 vs. 55.6%; P=0.02). PCT was higher in sepsis patients [median 0.32 ng/ml (IQR 0.19-1.17) vs. 0.18 ng/ml (IQR 0.07-0.54); P=0.04]. There were no differences between groups for MRproADM, MRproANP, copeptin, or proET-1 (P≥0.53). The C-statistic was maximized with the combination of SIRS criteria and PCT levels (0.92±0.05), which was better than PCT alone (0.67±0.08; P=0.005) or SIRS alone (0.75±0.07; P=0.04).
In this pilot study, we found that the combination of SIRS criteria and PCT levels is useful for the early detection of sepsis in ED patients with suspected infection. Larger studies investigating use of PCT are necessary.
在重症监护环境中，越来越多的中区域前肾上腺髓质素（MRproADM）、中区域前心房利钠肽（MRproANP）、降钙素原（PCT）、 copeptin 和内皮素-1 前肽（proET-1）与脓毒症的严重程度增加相关。本研究的目的是探讨脓毒症生物标志物在急诊科（ED）人群中的应用。
通过前瞻性观察性试点研究，我们调查了 MRproADM、MRproANP、PCT、copeptin 和 proET-1 在预测因疑似感染就诊 ED 的患者早期脓毒症诊断中的效用。使用非参数曼-惠特尼 U 检验、卡方检验和受试者工作特征曲线分析数据。
本研究共纳入 66 例患者，其中 37 例（56.1%）为男性，中位年龄为 58 岁[四分位间距（IQR）39-69 岁]，19 例（28.8%）最终诊断为早期脓毒症。与无脓毒症患者相比，脓毒症患者在初始表现时符合全身炎症反应综合征（SIRS）标准的比例更高（85.7%比 41.3%；P<0.0001），且住院率更高（84.2%比 55.6%；P=0.02）。脓毒症患者 PCT 水平较高[中位数 0.32ng/ml（IQR 0.19-1.17）比 0.18ng/ml（IQR 0.07-0.54）；P=0.04]。MRproADM、MRproANP、copeptin 或 proET-1 组间无差异（P≥0.53）。SIRS 标准和 PCT 水平的组合的 C 统计量最大（0.92±0.05），优于 PCT 单独（0.67±0.08；P=0.005）或 SIRS 单独（0.75±0.07；P=0.04）。
在这项试点研究中，我们发现 SIRS 标准和 PCT 水平的组合可用于早期检测疑似感染的 ED 患者的脓毒症。需要进一步研究 PCT 的应用。
