Miglietta Fabio, Faneschi Maria Letizia, Lobreglio Giambattista, Palumbo Claudio, Rizzo Adriana, Cucurachi Marco, Portaccio Gerolamo, Guerra Francesco, Pizzolante Maria
Laboratory of Microbiology, Vito Fazzi Regional Hospital, Lecce, Italy.
Laboratory of Clinical Pathology, Vito Fazzi Regional Hospital, Lecce, Italy.
Infez Med. 2015 Sep;23(3):230-7.
The aim of this study was to evaluate procalcitonin (PCT), C-reactive protein (CRP), platelet count (PLT) and serum lactate dehydrogenase (LDH) as early markers for diagnosis of SIRS, bacterial sepsis and systemic candidiasis in intensive care unit (ICU) patients. Based on blood culture results, the patients were divided into a sepsis group (70 patients), a SIRS group (42 patients) and a systemic candidiasis group (33 patients). PCT, CRP, LDH and PLT levels were measured on day 0 and on day 2 from the sepsis symptom onset. PCT levels were higher in Gram negative sepsis than those in Gram positive sepsis, although the P value between the two subgroups is not significant (P=0.095). Bacterial sepsis group had higher PCT and CRP levels compared with the systemic candidiasis group, whereas PLT and LDH levels showed similar levels in these two subgroups. The AUC for PCT (AUC: 0.892, P <0.001) was larger than for CRP (AUC: 0.738, P <0.001). The best cut-off values for PCT and CRP were 0.99 ng/mL and 76.2 mg/L, respectively. Diagnostic sensitivity and specificity for PCT were 84.3% and 81.8% whereas CRP showed a sensitivity of 77.2% and a specificity of 63.6%. However, PCT was unable to discriminate between SIRS and systemic candidiasis groups (P=0.093 N.S.). In conclusion, PCT can be used as a preliminary marker in the event of clinical suspicion of systemic candidiasis; however, low PCT levels (<0.99 ng/mL) necessarily require the use of other specific markers of candidaemia to confirm the diagnosis, due to great uniformity of PCT levels in systemic candidiasis and SIRS groups.
本研究旨在评估降钙素原（PCT）、C反应蛋白（CRP）、血小板计数（PLT）和血清乳酸脱氢酶（LDH）作为重症监护病房（ICU）患者全身炎症反应综合征（SIRS）、细菌性败血症和系统性念珠菌病早期诊断标志物的价值。根据血培养结果，将患者分为败血症组（70例）、SIRS组（42例）和系统性念珠菌病组（33例）。在败血症症状出现后的第0天和第2天测量PCT、CRP、LDH和PLT水平。革兰阴性菌败血症患者的PCT水平高于革兰阳性菌败血症患者，尽管两个亚组之间的P值无统计学意义（P=0.095）。细菌性败血症组的PCT和CRP水平高于系统性念珠菌病组，而这两个亚组的PLT和LDH水平相似。PCT的曲线下面积（AUC：0.892，P<0.001）大于CRP（AUC：0.738，P<0.001）。PCT和CRP的最佳截断值分别为0.99 ng/mL和76.2 mg/L。PCT的诊断敏感性和特异性分别为84.3%和81.8%，而CRP的敏感性为77.2%，特异性为63.6%。然而，PCT无法区分SIRS组和系统性念珠菌病组（P=0.093，无统计学意义）。总之，在临床怀疑系统性念珠菌病时，PCT可作为初步标志物；然而，由于系统性念珠菌病组和SIRS组的PCT水平非常一致，PCT水平低（<0.99 ng/mL）时必然需要使用其他念珠菌血症特异性标志物来确诊。
