Department of Microbiology, Antalya Training and Research Hospital, Antalya, Turkey.
Int J Med Sci. 2013 Aug 20;10(10):1367-74. doi: 10.7150/ijms.6014. eCollection 2013.
To determine the role of serum procalcitonin levels in predicting ascites infection in hospitalized cirrhotic and non-cirrhotic patients.
A total of 101 patients (mean age: 63.4 ± 1.3, 66.3% were males) hospitalized due to cirrhosis (n=88) or malignancy related (n=13) ascites were included in this study. Spontaneous bacterial peritonitis (SBP, 19.8%), culture-negative SBP (38.6%), bacterascites (4.9%), sterile ascites (23.8%) and malign ascites (12.9%) groups were compared in terms of procalcitonin levels in predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels and predicting outcome of procalcitonin levels was compared with C-reactive protein (CRP).
Culture positivity was determined in 26.7% of overall population. Serum procalcitonin levels were determined to be significantly higher in patients with positive bacterial culture in ascitic fluid compared to patients without culture positivity (median (min-max): 4.1 (0.2-36.4) vs. 0.4 (0.04-15.8), p<0.001). Using ROC analysis, a serum procalcitonin level of <0.61 ng/mL in SBP (area under curve (AUC): 0.981, CI 95%: 0.000-1.000, p<0.001), <0.225 ng/mL in culture-negative SBP (AUC: 0.743, CI 95%: 0.619-0.867, p<0.001), <0.42 ng/mL in SBP and culture-negative SBP patients (AUC: 0.824, CI 95%: 0.732-0.916, p<0.001), and <1.12 ng/mL in bacterascites (AUC: 0.837, CI 95%: 0.000-1.000, p=0.019) were determined to accurately rule out the diagnosis of bacterial peritonitis. Predictive power of serum procalcitonin levels in SBP + culture-negative SBP group (AUCs: 0.824 vs 0.622, p=0.004, Fig 4), culture-positive SBP (AUCs: 0.981 vs 0.777, p=0.006, Fig 5) and (although less powerfull) in culture-negative SBP (AUCs: 0.743 vs 0.543, p=0.02, Fig 6) were found significantly higher than CRP.
According to our findings determination of serum procalcitonin levels seems to provide satisfactory diagnostic accuracy in differentiating bacterial infections in hospitalized patients with liver cirrhosis related ascites.
确定血清降钙素原水平在预测住院肝硬化和非肝硬化患者腹水感染中的作用。
本研究纳入了 101 名（平均年龄：63.4±1.3，66.3%为男性）因肝硬化（n=88）或恶性肿瘤相关（n=13）腹水住院的患者。比较自发性细菌性腹膜炎（SBP，19.8%）、培养阴性的 SBP（38.6%）、菌性腹水（4.9%）、无菌性腹水（23.8%）和恶性腹水（12.9%）组在预测腹水感染时降钙素原水平的差异。使用受试者工作特征（ROC）曲线评估降钙素原水平的诊断性能，并比较降钙素原水平与 C 反应蛋白（CRP）预测结局的差异。
总体人群中确定了 26.7%的培养阳性。与无培养阳性的患者相比，腹水培养阳性患者的血清降钙素原水平显著升高（中位数（最小-最大）：4.1（0.2-36.4）与 0.4（0.04-15.8），p<0.001）。使用 ROC 分析，SBP 中降钙素原水平<0.61ng/ml（曲线下面积（AUC）：0.981，95%CI：0.000-1.000，p<0.001）、培养阴性的 SBP 中降钙素原水平<0.225ng/ml（AUC：0.743，95%CI：0.619-0.867，p<0.001）、SBP 和培养阴性的 SBP 患者中降钙素原水平<0.42ng/ml（AUC：0.824，95%CI：0.732-0.916，p<0.001）和菌性腹水患者中降钙素原水平<1.12ng/ml（AUC：0.837，95%CI：0.000-1.000，p=0.019）可准确排除细菌性腹膜炎的诊断。SBP+培养阴性的 SBP 组（AUCs：0.824 与 0.622，p=0.004，图 4）、培养阳性的 SBP（AUCs：0.981 与 0.777，p=0.006，图 5）和（尽管效力较低）培养阴性的 SBP（AUCs：0.743 与 0.543，p=0.02，图 6）的降钙素原水平预测能力显著高于 CRP。
根据我们的研究结果，测定血清降钙素原水平似乎可以提供令人满意的诊断准确性，以区分肝硬化相关腹水住院患者的细菌感染。
