Hamada Imam Mahmoud, Gamal Eman
Internal Medicine Department, Benha University, Benha, Qalubia - Egypt.
Clinical Pathology Department, Benha University, Benha, Qalubia - Egypt.
J Vasc Access. 2017 Nov 17;18(6):498-502. doi: 10.5301/jva.5000765. Epub 2017 Jul 26.
Catheter-related bloodstream infection (CRBSI) is a frequent complication among hemodialysis patients who usually are presented with nonspecific signs such as fever, rigors, and hypotension. Blood culture will take up to 5 days and antimicrobials will be started. Procalcitonin (PCT) is a valid marker in sepsis. Our goal in this study is to evaluate its usefulness as a diagnostic marker in detecting CRBSI among hemodialysis patients who present with suspected CRBSI.
Thirty-one hemodialysis patients with suspected CRBSI were enrolled in this study. PCT level was measured at the time of presentation. Patients were divided into two groups according to blood culture results: positive and negative groups. PCT level and other markers for inflammation: white blood cell count (WBC), C-reactive protein (CRP), and ferritin were compared between the two groups. Statistical analysis of variables was performed using the t-test or Mann-Whitney test together with Spearman correlation test.
Thirty-one patients had median age 44.7 ± 2.1 years. They comprised 16 males (52%) and 15 females (48%). Sixteen patients had a positive blood culture result while in 15 it was negative. PCT level was significantly higher in the positive blood culture group (40.0 ± -21.9) (95% confidence interval [CI] 28.4-51.8) while its level was 1.1 ± 1 (95% CI 0.54-1.8) in the negative blood culture group [t(15) = -7, p<0.001). In the positive culture group, there was a correlation between CRP and ferritin (r = -0.58, p = 0.01, n = 16), while no correlation between PCT and other markers of inflammation.
PCT is a useful marker for diagnosis of CRBSI among hemodialysis patients.
导管相关血流感染（CRBSI）是血液透析患者中常见的并发症，这些患者通常表现出发热、寒战和低血压等非特异性症状。血培养需要长达5天时间，且会开始使用抗菌药物。降钙素原（PCT）是脓毒症的有效标志物。我们在本研究中的目标是评估其作为诊断标志物在检测疑似CRBSI的血液透析患者中的CRBSI的有用性。
31名疑似CRBSI的血液透析患者纳入本研究。在就诊时测量PCT水平。根据血培养结果将患者分为两组：阳性组和阴性组。比较两组之间的PCT水平以及其他炎症标志物：白细胞计数（WBC）、C反应蛋白（CRP）和铁蛋白。使用t检验或曼-惠特尼检验以及斯皮尔曼相关性检验对变量进行统计分析。
31名患者的中位年龄为44.7±2.1岁。其中男性16名（52%），女性15名（48%）。16名患者血培养结果为阳性，15名患者为阴性。血培养阳性组的PCT水平显著更高（40.0± -21.9）（95%置信区间[CI]为28.4 - 51.8），而血培养阴性组的PCT水平为1.1±1（95%CI为0.54 - 1.8）[t(15)= -7，p<0.001]。在阳性培养组中，CRP与铁蛋白之间存在相关性（r = -0.58，p = 0.01，n = 16），而PCT与其他炎症标志物之间无相关性。
PCT是血液透析患者诊断CRBSI的有用标志物。
