钙卫蛋白作为重症患者细菌感染的早期生物标志物：一项探索性队列评估。

Calprotectin as an early biomarker of bacterial infections in critically ill patients: an exploratory cohort assessment.

作者信息

Jonsson Niklas, Nilsen Tom, Gille-Johnson Patrik, Bell Max, Martling Claes-Roland, Larsson Anders, Mårtensson Johan

机构信息

Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.

Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.

出版信息

Crit Care Resusc. 2017 Sep;19(3):205-213.

PMID:28866970

Abstract

BACKGROUND

Calprotectin is the most abundant protein in the cytosolic fraction of neutrophils, and neutrophil degranulation is a major response to bacterial infections.

OBJECTIVES

To assess the value of plasma calprotectin as an early marker of bacterial infections in critically ill patients and compare it with the corresponding values for procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC).

METHODS

We measured daily plasma calprotectin levels in 110 intensive care unit patients using a newly developed turbidimetric assay run on clinical chemistry analysers. The likelihood of infection was determined according to the International Sepsis Forum criteria.

RESULTS

Overall, 58 patients (52.7%) developed a suspected or confirmed bacterial infection. Plasma calprotectin predicted such infections within 24 hours with an area under the receiver operating characteristics curve (ROC area) of 0.78 (95% CI, 0.68-0.89). The ROC area for calprotectin was significantly greater than the corresponding ROC areas for WBC (P < 0.001) and PCT (P = 0.02) but only marginally better than the ROC area for CRP (0.71; 95% CI, 0.68-0.89).

CONCLUSION

Plasma calprotectin appears to be a useful early marker of bacterial infections in critically ill patients, with better predictive characteristics than WBC and PCT.

摘要

背景

钙卫蛋白是中性粒细胞胞质组分中含量最丰富的蛋白质，而中性粒细胞脱颗粒是对细菌感染的主要反应。

目的

评估血浆钙卫蛋白作为重症患者细菌感染早期标志物的价值，并将其与降钙素原（PCT）、C反应蛋白（CRP）及白细胞计数（WBC）的相应值进行比较。

方法

我们使用在临床化学分析仪上运行的新开发的比浊法，每日测量110例重症监护病房患者的血浆钙卫蛋白水平。根据国际脓毒症论坛标准确定感染的可能性。

结果

总体而言，58例患者（52.7%）发生了疑似或确诊的细菌感染。血浆钙卫蛋白在24小时内预测此类感染的受试者工作特征曲线下面积（ROC面积）为0.78（95%CI，0.68 - 0.89）。钙卫蛋白的ROC面积显著大于WBC（P < 0.001）和PCT（P = 0.02）的相应ROC面积，但仅略优于CRP的ROC面积（0.71；95%CI，0.68 - 0.89）。