Choe Eun A, Shin Tae Gun, Jo Ik Joon, Hwang Sung Yeon, Lee Tae Rim, Cha Won Chul, Sim Min Seob
Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Shock. 2016 Jul;46(1):37-43. doi: 10.1097/SHK.0000000000000566.
The aims of this study were to evaluate the prevalence of low procalcitonin (PCT) levels among patients with severe sepsis or septic shock, and to investigate clinical characteristics and outcomes associated with low PCT levels.
We analyzed data from the sepsis registry for patients with severe sepsis or septic shock in the emergency department. Based on a specific PCT cutoff value, patients were classified into two groups: a low PCT group, PCT <0.25 ng/mL; and a high PCT group, PCT ≥0.25 ng/mL. The primary endpoint was 28-day mortality. A multivariable logistic regression model was used to evaluate independent factors associated with low PCT and 28-day mortality.
A total of 1,212 patients were included. Of the eligible patients, 154 (12.7%) were assigned to the low PCT group, and 1,058 (87.3%) to the high PCT group. The 28-day mortality was 4.6% in the low PCT group and 13.5% in the high PCT group (P < 0.01). The adjusted odds ratio of the low PCT group for 28-day mortality was 0.43 (95% CI 0.19-0.98; P = 0.04). There was no trend of increasing mortality among higher PCT level patients. In a logistic regression model, factors associated with low PCT were pneumonia, lower C-reactive protein levels, lower lactate levels, the absence of bacteremia, and the absence of organ failure. Intra-abdominal infection and obesity were associated with high PCT.
Initial low PCT levels were common among patients diagnosed with severe sepsis or septic shock in the emergency department, suggesting favorable outcomes. The prevalence of low PCT levels was significantly different according to obesity, the source of infection, C-reactive protein levels, lactate levels, bacteremia, and organ failure.
本研究旨在评估严重脓毒症或脓毒性休克患者中降钙素原（PCT）水平较低的患病率，并调查与低PCT水平相关的临床特征及预后。
我们分析了急诊科严重脓毒症或脓毒性休克患者的脓毒症登记数据。根据特定的PCT临界值，将患者分为两组：低PCT组，PCT<0.25 ng/mL；高PCT组，PCT≥0.25 ng/mL。主要终点为28天死亡率。采用多变量逻辑回归模型评估与低PCT及28天死亡率相关的独立因素。
共纳入1212例患者。符合条件的患者中，154例（12.7%）被分配至低PCT组，1058例（87.3%）被分配至高PCT组。低PCT组的28天死亡率为4.6%，高PCT组为13.5%（P<0.01）。低PCT组28天死亡率的调整优势比为0.43（95%CI 0.19 - 0.98；P = 0.04）。PCT水平较高的患者中没有死亡率增加的趋势。在逻辑回归模型中，与低PCT相关的因素包括肺炎、较低的C反应蛋白水平、较低的乳酸水平、无菌血症以及无器官衰竭。腹腔内感染和肥胖与高PCT相关。
急诊科诊断为严重脓毒症或脓毒性休克的患者中，初始PCT水平较低很常见，提示预后良好。低PCT水平的患病率根据肥胖、感染源、C反应蛋白水平、乳酸水平、菌血症和器官衰竭的不同而有显著差异。
