Cha Joo Kyoung, Kwon Ki Hwan, Byun Seung Joo, Ryoo Soo Ryeong, Lee Jeong Hyeon, Chung Jae-Woo, Huh Hee Jin, Chae Seok Lae, Park Seong Yeon
Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
Korean J Intern Med. 2018 Jan;33(1):176-184. doi: 10.3904/kjim.2016.119. Epub 2017 Nov 8.
BACKGROUND/AIMS: Procalcitonin (PCT) may prove to be a useful marker to exclude or predict bloodstream infection (BSI). However, the ability of PCT levels to differentiate BSI from non-BSI episodes has not been evaluated in nosocomial BSI.
We retrospectively reviewed the medical records of patients ≥ 18 years of age with suspected BSI that developed more than 48 hours after admission.
Of the 785 included patients, 105 (13.4%) had BSI episodes and 680 (86.6%) had non-BSI episodes. The median serum PCT level was elevated in patients with BSI as compared with those without BSI (0.65 ng/mL vs. 0.22 ng/mL, = 0.001). The optimal PCT cut-off value of BSI was 0.27 ng/mL, with a corresponding sensitivity of 74.6% (95% confidence interval [CI], 66.4% to 81.7%) and a specificity of 56.5% (95% CI, 52.7% to 60.2%). The area under curve of PCT (0.692) was significantly larger than that of C-reactive protein (CRP; 0.526) or white blood cell (WBC) count (0.518). However, at the optimal cut-off value, PCT failed to predict BSI in 28 of 105 cases (26.7%). The PCT level was significantly higher in patients with an eGFR < 60 mL/min/1.73 m than in those with an eGFR ≥ 60 mL/min/1.73 m (0.68 vs. 0.17, = 0.01).
PCT was more useful for predicting nosocomial BSI than CRP or WBC count. However, the diagnostic accuracy of predicting BSI remains inadequate. Thus, PCT is not recommended as a single diagnostic tool to avoid taking blood cultures in the nosocomial setting.
背景/目的：降钙素原（PCT）可能是排除或预测血流感染（BSI）的有用标志物。然而，在医院获得性BSI中，PCT水平区分BSI与非BSI发作的能力尚未得到评估。
我们回顾性分析了入院48小时后发生疑似BSI的18岁及以上患者的病历。
在纳入的785例患者中，105例（13.4%）发生BSI发作，680例（86.6%）发生非BSI发作。与无BSI的患者相比，BSI患者的血清PCT水平中位数升高（0.65 ng/mL对0.22 ng/mL，P = 0.001）。BSI的最佳PCT临界值为0.27 ng/mL，相应的敏感性为74.6%（95%置信区间[CI]，66.4%至81.7%），特异性为56.5%（95%CI，52.7%至60.2%）。PCT的曲线下面积（0.692）显著大于C反应蛋白（CRP；0.526）或白细胞（WBC）计数（0.518）。然而，在最佳临界值时，PCT未能在105例中的28例（26.7%）中预测BSI。估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²的患者PCT水平显著高于eGFR≥60 mL/min/1.73 m²的患者（0.68对0.17，P = 0.01）。
PCT在预测医院获得性BSI方面比CRP或WBC计数更有用。然而，可以预测BSI的诊断准确性仍然不足。因此，不建议将PCT作为单一诊断工具来避免在医院环境中进行血培养。
