前降钙素原（可溶性CD14亚型）及CURB65评分系统在急诊科预测社区获得性肺炎严重程度及预后中的作用

Role of Presepsin (sCD14-ST) and the CURB65 scoring system in predicting severity and outcome of community-acquired pneumonia in an emergency department.

作者信息

Liu Bo, Yin Qin, Chen Yun-Xia, Zhao Yun-Zhou, Li Chun-Sheng

机构信息

Emergency Department, Beijing Chao-Yang Hospital of the Capital Medical University, Beijing 100020, China.

出版信息

Respir Med. 2014 Aug;108(8):1204-13. doi: 10.1016/j.rmed.2014.05.005. Epub 2014 Jun 2.

DOI:10.1016/j.rmed.2014.05.005

PMID:24931899

Abstract

INTRODUCTION

CD14 is one of the leukocyte differentiation antigens, and is present in macrophages, monocytes, granulocytes and their cell membranes. Presepsin, namely soluble CD14-subtype (sCD14-ST) is produced by circulating plasma proteases activating cleavage of soluble CD14 (sCD14). The aim of this study is to investigate the role of Presepsin and the CURB65 scoring system in the evaluation of severity and outcome of CAP in an ED.

METHOD

A prospective, observational study was performed in an ED of an university teaching hospital from November 2011 to October 2012. A total of 359 patients with CAP and 214 patients with severe CAP (SCAP) were consecutively enrolled. Plasma Presepsin, lactate, serum PCT levels and leukocyte counts were measured and CURB65 score were calculated at admission enrollment.

RESULT

Plasma Presepsin levels were significantly higher in SCAP patients than in CAP patients (P < 0.0001), increasing correspondingly with the enhancement of CURB65 score. Patients with ARDS or DIC had obviously higher plasma Presepsin levels than those without ARDS or DIC (all P < 0.0001), and plasma Presepsin levels were significantly higher in non-survivors than in survivors at 28-day follow-up. In logistic regression analysis, CURB65 score was the independent predictor of ARDS, and Presepsin was the independent predictor of DIC, and Presepsin and CURB65 score were both the independent predictors of 28-day mortality. The AUCs showed Presepsin in combination with CURB65 score in predicting ARDS, SCAP and 28-day mortality was superior to Presepsin or CURB65 score alone ( all P < 0.01), Presepsin was better than CURB65 score and leukocyte in predicting DIC ( P < 0.01).

CONCLUSION

Presepsin is a valuable biomarker in predicting severity and outcome in CAP patients in the ED and Presepsin in combination with CURB65 score significantly enhanced the predictive accuracy.

摘要

引言

CD14是一种白细胞分化抗原，存在于巨噬细胞、单核细胞、粒细胞及其细胞膜上。可溶性CD14亚型（sCD14-ST）即可溶性预脂素，由循环血浆蛋白酶激活裂解可溶性CD14（sCD14）产生。本研究旨在探讨可溶性预脂素和CURB65评分系统在急诊科评估社区获得性肺炎（CAP）严重程度及预后中的作用。

方法

2011年11月至2012年10月在一所大学教学医院的急诊科进行了一项前瞻性观察研究。连续纳入359例CAP患者和214例重症CAP（SCAP）患者。入院时测定血浆可溶性预脂素、乳酸、血清降钙素原（PCT）水平及白细胞计数，并计算CURB65评分。

结果

SCAP患者血浆可溶性预脂素水平显著高于CAP患者（P<0.0001），且随CURB65评分升高而相应升高。发生急性呼吸窘迫综合征（ARDS）或弥散性血管内凝血（DIC）的患者血浆可溶性预脂素水平明显高于未发生ARDS或DIC的患者（均P<0.0001），28天随访时非存活者的血浆可溶性预脂素水平显著高于存活者。在逻辑回归分析中，CURB65评分是ARDS的独立预测因子，可溶性预脂素是DIC的独立预测因子，可溶性预脂素和CURB65评分均是28天死亡率的独立预测因子。受试者工作特征曲线下面积（AUC）显示，可溶性预脂素联合CURB65评分预测ARDS、SCAP和2-8天死亡率优于单独使用可溶性预脂素或CURB65评分（均P<0.01），可溶性预脂素在预测DIC方面优于CURB65评分和白细胞计数（P<0.01）。