Rowland Tim, Hilliard Heather, Barlow Gavin
Department of Respiratory Medicine, Nobles Hospital, Strang, Isle of Man.
North Yorkshire and East Coast Foundation School, Hull and East Yorkshire Hospitals NHS Trust, Yorkshire, United Kingdom.
Adv Clin Chem. 2015;68:71-86. doi: 10.1016/bs.acc.2014.11.005. Epub 2015 Jan 7.
Sepsis is an important cause of worldwide morbidity and mortality. Early recognition and diagnosis are keys to achieving improved outcomes. Procalcitonin has been widely investigated as a potential biomarker for sepsis. Furthermore, management of sepsis and other infectious disease is becoming increasingly complicated by the emergence of antibiotic resistant strains of pathogens. Good antibiotic governance is important in reducing the risk of the development of further antibiotic resistance. We reviewed the current literature on the use of procalcitonin in sepsis to determine whether it should be recommended for use in either of these roles. Procalcitonin should not be used as a stand-alone diagnostic test to rule-in or rule-out sepsis or bacterial infection, or for prognostication, in the absence of clinical judgment. Used as part of a clinical algorithm, however, it has been shown to reduce antibiotic prescribing in critical care environments and for respiratory tract infections.
脓毒症是全球发病和死亡的重要原因。早期识别和诊断是改善预后的关键。降钙素原已被广泛研究作为脓毒症的潜在生物标志物。此外，由于病原体抗生素耐药菌株的出现，脓毒症和其他传染病的管理正变得越来越复杂。良好的抗生素管理对于降低进一步产生抗生素耐药性的风险很重要。我们回顾了目前关于降钙素原在脓毒症中应用的文献，以确定是否应推荐其用于上述任何一种情况。在缺乏临床判断的情况下，降钙素原不应作为单独的诊断测试来确诊或排除脓毒症或细菌感染，也不应用于预后评估。然而，作为临床算法的一部分使用时，它已被证明可减少重症监护环境中以及呼吸道感染时的抗生素处方。
