Bodmann K F, Schenker M, Heinlein W, Wilke M H
Klinik für internistische Intensiv- und Notfallmedizin und Klinische Infektiologie, Werner-Forßmann-Krankenhaus, Klinikum Barnim GmbH, Rudolf-Breitscheid-Str. 100, 16225, Eberswalde, Deutschland.
Inspiring-health, Dr. Wilke GmbH, München, Deutschland.
Med Klin Intensivmed Notfmed. 2018 Oct;113(7):533-541. doi: 10.1007/s00063-016-0183-7. Epub 2016 Jul 4.
Procalcitonin (PCT) is a well-evaluated biomarker for the detection of severe bacterial infections and monitoring effectiveness of antibiotic therapy. This study aims to evaluate the usefulness of PCT in a clinical routine setting.
Of 358,763 clinical cases from 7 German hospitals in 2012 and 2013, 3854 cases had an ICD-10 code representing sepsis. A total of 1778 cases had pathologic PCT and one episode of infection. Of those, 671 showed a series of measures that was suitable to assess treatment success using PCT reduction. Propensity score matching was used to create two comparable groups with 211 patients in each group.
The group with PCT reduction within 12 days showed a highly significant better proportion of survival (146/211 vs. 17/211; p < 0.0001). The odds ratio for death according to PCT reduction vs. nonreduction is 25.64 (p < 0.0001; 95 % CI: 14.49-45.45). PCT was normalized after an average of 6.2 days.
The difference in survival implicates that PCT reduction is a suitable surrogate parameter to indicate successful antimicrobial therapy. Successful antibiotic therapy is a proven predictor for survival in sepsis. This study also showed concordant results in the group of patients with sepsis after abdominal surgery. Results from subgroup analyses confirm the initial findings. PCT reduction was used as surrogate for therapy success, as the antimicrobial therapy was not electronically available.
PCT reduction is a strong predictor for survival. However, the data show that overall use of PCT to monitor sepsis therapy is not yet routinely established. Hospitals should establish algorithms for sepsis treatment that include PCT for the assessment of adequacy and the monitoring of success of the antimicrobial therapy.
降钙素原（PCT）是一种经过充分评估的生物标志物，用于检测严重细菌感染及监测抗生素治疗效果。本研究旨在评估PCT在临床常规环境中的实用性。
在2012年和2013年德国7家医院的358763例临床病例中，3854例具有代表脓毒症的国际疾病分类第十版（ICD - 10）编码。共有1778例病例PCT异常且有一次感染发作。其中，671例显示出一系列适合使用PCT降低来评估治疗成功与否的措施。采用倾向评分匹配法创建了两个可比组，每组211例患者。
在12天内PCT降低的组显示出显著更高的生存率（146/211对17/211；p < 0.0001）。根据PCT降低与否计算的死亡比值比为25.64（p < 0.0001；95%置信区间：14.49 - 45.45）。PCT平均在6.2天后恢复正常。
生存率的差异表明PCT降低是表明抗菌治疗成功的合适替代参数。成功的抗生素治疗是脓毒症患者生存的已证实预测指标。本研究在腹部手术后脓毒症患者组中也显示出一致结果。亚组分析结果证实了最初发现。由于抗菌治疗的电子记录不可用，PCT降低被用作治疗成功的替代指标。
PCT降低是生存的有力预测指标。然而，数据表明PCT用于监测脓毒症治疗尚未常规确立。医院应建立脓毒症治疗算法，包括使用PCT评估抗菌治疗的充分性和监测治疗成功与否。
