Godnic Matej, Stubljar David, Skvarc Miha, Jukic Tomislav
Novo mesto General Hospital, Novo mesto, Slovenia.
Wien Klin Wochenschr. 2015 Jul;127(13-14):521-7. doi: 10.1007/s00508-015-0719-5. Epub 2015 Apr 9.
Sepsis is a serious problem in intensive care units all over the world. Biomarkers could be useful to identify patients at risk. We focused especially on the performance of presepsin (sCD14-ST), compared to C-reactive protein (CRP), procalcitonin (PCT) and CD64, to determine its diagnostic and prognostic indications.
The study was conducted on 47 hospitalized patients after procedures, who were divided into three groups; systemic inflammatory response (SIRS), sepsis and septic shock. Expression of CD64 on neutrophils presented as CD64 index, sCD14-ST, CRP and PCT were measured in whole blood or plasma samples. All patients had standard samples like urine, respiratory tract samples etc. taken for culturing. Blood cultures were drawn to confirm bloodstream infection.
Forty (85 %) patients had SIRS with bacterial infection and seven (15 %) patients had SIRS with no infection. All infections were confirmed with blood cultures. Biomarkers were evaluated in all patients. In patients with confirmed infection the values were high. The patients with bacterial infection showed statistical significance with CD64 index (p = 0.003), CRP (p = 0.049) and sCD14-ST (p = 0.026), but not with PCT (p = 1.000). The severity of diagnosed SIRS was significant only with PCT (p < 0.001).
CD64 index, CRP and sCD14-ST served as good parameters to determine possible infection in patients that needed intensive care after major procedures. Values of PCT were the only ones to predict SIRS severity and could distinguish between sepsis and severe sepsis or septic shock.
脓毒症是全球重症监护病房面临的一个严重问题。生物标志物有助于识别有风险的患者。我们特别关注可溶性髓系细胞触发受体-1（sCD14-ST）与C反应蛋白（CRP）、降钙素原（PCT）和CD64相比的性能，以确定其诊断和预后指征。
对47例术后住院患者进行了研究，这些患者被分为三组：全身炎症反应（SIRS）、脓毒症和感染性休克。在全血或血浆样本中测量中性粒细胞上CD64的表达（以CD64指数表示）、sCD14-ST、CRP和PCT。所有患者均采集了尿液、呼吸道样本等标准样本进行培养。采集血培养以确认血流感染。
40例（85%）患者发生伴有细菌感染的SIRS，7例（15%）患者发生无感染的SIRS。所有感染均经血培养确诊。对所有患者的生物标志物进行了评估。在确诊感染的患者中，这些值较高。细菌感染患者的CD64指数（p = 0.003）、CRP（p = 0.049）和sCD14-ST（p = 0.026）有统计学意义，但PCT无统计学意义（p = 1.000）。仅PCT与确诊SIRS的严重程度有显著相关性（p < 0.001）。
CD64指数、CRP和sCD14-ST是确定大手术后需要重症监护的患者是否可能感染的良好参数。PCT值是预测SIRS严重程度的唯一指标，并且可以区分脓毒症与严重脓毒症或感染性休克。
