初始降钙素原及降钙素原清除率对自身免疫性疾病危重症患者细菌感染及预后的预测价值：一项前瞻性观察性研究
The utility of initial procalcitonin and procalcitonin clearance for prediction of bacterial infection and outcome in critically ill patients with autoimmune diseases: a prospective observational study.
作者信息
Shi Yan, Peng Jin-min, Hu Xiao-yun, Wang Yao
机构信息
Department of general intensive care unit, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of medical intensive care unit, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
出版信息
BMC Anesthesiol. 2015 Oct 7;15:137. doi: 10.1186/s12871-015-0122-9.
BACKGROUND
The diagnostic value of procalcitonin (PCT) for patients with autoimmune diseases (AID) remains controversial and few studies focused on ICU patients. We sought to determine its diagnostic and prognostic values in this clowd.
METHODS
A prospective observational study was conducted in AID patients admitted to the ICU. Serum PCT levels were measured on ICU admission and subsequently at days 1, 3, 5 and 7, and peak PCT levels within 24 h (PCTpeak) were analyzed the utility for bacterial infection. The relationship of PCTpeak and SOFA score and severity of sepsis was performed correlation analysis. The change of PCT over time reflected as PCT clearance was compared to ICU 28-day mortality.
RESULTS
One hundred twelve patients were divided into bacterial infection group (group I, n = 54) and nonbacterial condition group (group II, n = 58). The median PCTpeak (range, μg/L) was higher in the group I than that in the group II (1.95 [0.38-37.56] vs. 0.64 [0.05-7.83], p = 0.002). PCTpeak had the best single predictor of bacterial infection (area under the curve [AUC], 0.902, p < 0.001) with a sensitivity of 79.6 % and a specificity of 89.6 % at the threshold of 0.94 μg/L. PCTpeak was also positive correlation with severity of sepsis (r = 0.731, p = 0.002), but its correlation with SOFA score was only found in subjects with bacterial infection (r = 0.798, p < 0.001). Importantly, the 5-day PCT clearance (PCTc-d5), rather than absolute PCT values, could earlier discriminate survivors (n = 73) from nonsurvivors (n = 39) (68.8 ± 9.8 vs. 21.8 ± 17.5 %, p < 0.001, respectively). PCTc-d5 < 50 % was an independent predictor of mortality (odds ratio 5.1, 95 % confidence interval 3.5 to 7.5; p = 0.001).
CONCLUSIONS
In critically ill patients with AID, elevated PCT levels are valuable for bacterial infection and are significantly positive correlation with the septic severity. Five-day PCT clearance may provide independent prognostic information. Larger, prospective trials are warranted to confirm the benefit.
背景
降钙素原（PCT）对自身免疫性疾病（AID）患者的诊断价值仍存在争议，且很少有研究关注重症监护病房（ICU）患者。我们试图确定其在这一人群中的诊断和预后价值。
方法
对入住ICU的AID患者进行前瞻性观察研究。在患者入住ICU时、随后第1、3、5和7天测量血清PCT水平，并分析24小时内的PCT峰值（PCTpeak）对细菌感染的诊断作用。对PCTpeak与序贯器官衰竭评估（SOFA）评分及脓毒症严重程度的关系进行相关性分析。将PCT随时间的变化（以PCT清除率表示）与ICU 28天死亡率进行比较。
结果
112例患者分为细菌感染组（I组，n = 54）和非细菌感染组（II组，n = 58）。I组的PCTpeak中位数（范围，μg/L）高于II组（1.95 [0.38 - 37.56] 对比 0.64 [0.05 - 7.83]，p = 0.002）。PCTpeak是细菌感染的最佳单一预测指标（曲线下面积[AUC]，0.902，p < 0.001），在阈值为0.94 μg/L时，灵敏度为79.6%，特异度为89.6%。PCTpeak也与脓毒症严重程度呈正相关（r = 0.731，p = 0.002），但仅在细菌感染患者中发现其与SOFA评分相关（r = 0.798，p < 0.001）。重要的是，5天PCT清除率（PCTc - d5）而非PCT绝对值，能更早地区分存活者（n = 73）和非存活者（n = 39）（分别为68.8 ± 9.8%对比21.8 ± 17.5%，p < 0.001）。PCTc - d5 < 50%是死亡率的独立预测指标（比值比5.1，95%置信区间3.5至7.5；p = 0.001）。
结论
在患有AID重症患者中，PCT水平升高对细菌感染有诊断价值，且与脓毒症严重程度显著正相关。5天PCT清除率可能提供独立的预后信息。需要更大规模的前瞻性试验来证实其益处。
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