Karon Brad S, Tolan Nicole V, Wockenfus Amy M, Block Darci R, Baumann Nikola A, Bryant Sandra C, Clements Casey M
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States.
Clin Biochem. 2017 Nov;50(16-17):956-958. doi: 10.1016/j.clinbiochem.2017.05.014. Epub 2017 May 25.
Lactate, white blood cell (WBC) and neutrophil count, procalcitonin and immature granulocyte (IG) count were compared for the prediction of sepsis, and severe sepsis or septic shock, in patients presenting to the emergency department (ED).
We prospectively enrolled 501 ED patients with a sepsis panel ordered for suspicion of sepsis. WBC, neutrophil, and IG counts were measured on a Sysmex XT-2000i analyzer. Lactate was measured by i-STAT, and procalcitonin by Brahms Kryptor. We classified patients as having sepsis using a simplification of the 1992 consensus conference sepsis definitions. Patients with sepsis were further classified as having severe sepsis or septic shock using established criteria. Univariate receiver operating characteristic (ROC) analysis was performed to determine odds ratio (OR), area under the ROC curve (AUC), and sensitivity/specificity at optimal cut-off for prediction of sepsis (vs. no sepsis), and prediction of severe sepsis or septic shock (vs. no sepsis).
There were 267 patients without sepsis; and 234 with sepsis, including 35 patients with severe sepsis or septic shock. Lactate had the highest OR (1.44, 95th% CI 1.20-1.73) for the prediction of sepsis; while WBC, neutrophil count and percent (neutrophil/WBC) had OR>1.00 (p<0.05). All biomarkers had AUC<0.70 and sensitivity and specificity <70% at the optimal cut-off. Initial lactate was the best biomarker for predicting severe sepsis or septic shock, with an odds ratio (95th% CI) of 2.70 (2.02-3.61) and AUC 0.89 (0.82-0.96).
Traditional biomarkers (lactate, WBC, neutrophil count, procalcitonin, IG) have limited utility in the prediction of sepsis.
比较乳酸、白细胞（WBC）计数、中性粒细胞计数、降钙素原及未成熟粒细胞（IG）计数对急诊科就诊患者脓毒症、严重脓毒症或脓毒性休克的预测价值。
前瞻性纳入501例因怀疑脓毒症而进行脓毒症相关检查的急诊科患者。采用Sysmex XT - 2000i分析仪检测白细胞、中性粒细胞及未成熟粒细胞计数。采用i - STAT检测乳酸水平，采用Brahms Kryptor检测降钙素原。依据1992年脓毒症共识会议定义的简化版对患者进行脓毒症分类。采用既定标准将脓毒症患者进一步分为严重脓毒症或脓毒性休克患者。进行单因素受试者工作特征（ROC）分析，以确定预测脓毒症（与非脓毒症相比）以及预测严重脓毒症或脓毒性休克（与非脓毒症相比）的优势比（OR）、ROC曲线下面积（AUC）以及最佳截断值时的敏感性/特异性。
267例患者无脓毒症，234例患者有脓毒症，其中35例为严重脓毒症或脓毒性休克。乳酸对脓毒症预测的OR最高（1.44，95%可信区间1.20 - 1.73）；白细胞、中性粒细胞计数及百分比（中性粒细胞/白细胞）的OR>1.00（p<0.05）。所有生物标志物在最佳截断值时的AUC<0.70，敏感性和特异性<70%。初始乳酸是预测严重脓毒症或脓毒性休克的最佳生物标志物，优势比（95%可信区间）为2.70（2.02 - 3.61），AUC为0.89（0.82 - 0.96）。
传统生物标志物（乳酸、白细胞、中性粒细胞计数、降钙素原、未成熟粒细胞）在脓毒症预测中的效用有限。
