Friend Kara E, Burgess Jessica N, Britt Rebecca C, Collins Jay N, Weireter Leonard N, Novosel Timothy J, Britt L D
Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Am Surg. 2014 Sep;80(9):906-9.
Procalcitonin is used as a marker for sepsis but there is little known about the correlation of the procalcitonin elevation with the causative organism in sepsis. All patients aged 18 to 80 years who were admitted to the surgery service from June 2010 to May 2012 and who had a procalcitonin drawn were evaluated. Culture data were reviewed to determine the causative organism. Infections analyzed included pneumonia, urinary tract infection (UTI), bloodstream infection, and Clostridium difficile. Other parameters assessed included reason for admission, body mass index, pressor use, antibiotic duration, and disposition. Two hundred thirty-two patient records were reviewed. Patients without a known infection/source of sepsis had a mean procalcitonin of 3.95. Those with pneumonia had a procalcitonin of 20.59 (P = 0.03). Those with a UTI had a mean procalcitonin of 66.84 (P = 0.0005). Patients with a bloodstream infection had a mean procalcitonin of 33.30 (P = 0.003). Those with C. difficile had a procalcitonin of 47.20 (P = 0.004). When broken down by causative organisms, those with Gram-positive sepsis had a procalcitonin of 23.10 (P = 0.02) compared with those with Gram-negative sepsis at 32.75 (P = 0.02). Those with fungal infections had a procalcitonin of 42.90 (P = 0.001). These data suggest that procalcitonin elevation can help guide treatment by indicating likely causative organism and infection type. These data may provide a good marker for initiation of antifungal therapy.
降钙素原被用作脓毒症的标志物，但关于脓毒症中降钙素原升高与致病微生物之间的相关性却知之甚少。对2010年6月至2012年5月入住外科且检测了降钙素原的所有18至80岁患者进行了评估。回顾培养数据以确定致病微生物。分析的感染包括肺炎、尿路感染（UTI）、血流感染和艰难梭菌感染。评估的其他参数包括入院原因、体重指数、升压药使用情况、抗生素使用时长和出院情况。共审查了232份患者记录。无已知感染/脓毒症来源的患者降钙素原平均为3.95。肺炎患者的降钙素原为20.59（P = 0.03）。尿路感染患者的降钙素原平均为66.84（P = 0.0005）。血流感染患者的降钙素原平均为33.30（P = 0.003）。艰难梭菌感染患者的降钙素原为47.20（P = 0.004）。按致病微生物分类时，革兰氏阳性脓毒症患者的降钙素原为23.10（P = 0.02），而革兰氏阴性脓毒症患者的降钙素原为32.75（P = 0.02）。真菌感染患者的降钙素原为42.90（P = 0.001）。这些数据表明，降钙素原升高可通过指示可能的致病微生物和感染类型来帮助指导治疗。这些数据可能为启动抗真菌治疗提供一个良好的标志物。
