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降钙素原在腹部大手术后细菌感染诊断中的作用:每日检测的优势

The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery: Advantage from daily measurement.

作者信息

Spoto Silvia, Valeriani Emanuele, Caputo Damiano, Cella Eleonora, Fogolari Marta, Pesce Elena, Mulè Maria Tea, Cartillone Mariacristina, Costantino Sebastiano, Dicuonzo Giordano, Coppola Roberto, Ciccozzi Massimo, Angeletti Silvia

机构信息

Internal Medicine Department, University Campus Bio-Medico of Rome, Rome Internal Medicine Department, University G. D'Annunzio, Chieti Department of Surgery, University Campus Bio-Medico of Rome Department of Public Health and Infectious Diseases, Sapienza University of Rome Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy.

出版信息

Medicine (Baltimore). 2018 Jan;97(3):e9496. doi: 10.1097/MD.0000000000009496.

Abstract

Postsurgical infections represent an important cause of morbidity after abdominal surgery. The microbiological diagnosis is not achieved in at least 30% of culture with consequent worsening of patient outcome. In this study, procalcitonin measurement, during the first 3 days after abdominal surgery, has been evaluated for the early diagnosis of postsurgical infection.Ninety consecutive patients subjected to major abdominal surgery at the University Campus Bio-Medico of Rome, have been included. PCT concentrations were measured by time-resolved amplified cryptate emission (TRACE) assay at admission and at the first, second, and third day after surgery. PCT levels were compared using the Mann-Whitney test and by ANOVA test for variance analysis. Receiver operating characteristic (ROC) analysis was performed to define the diagnostic ability of PCT in case of postsurgical infections.PCT values resulted significantly different between patients developing or not developing postsurgical infections. PCT >1.0 ng/mL at first or second day after surgery and >0.5 ng/mL at third day resulted diagnostic for infectious complication, whereas a value <0.5 ng/mL at the fifth day after surgery was useful for early and safety discharge of patients.In conclusion, PCT daily measurement could represent a useful diagnostic tool improving health care in the postsurgical period following major abdominal surgery and should be recommended.

摘要

术后感染是腹部手术后发病的一个重要原因。至少30%的培养结果无法实现微生物学诊断,从而导致患者预后恶化。在本研究中,对腹部手术后前3天的降钙素原测量进行了评估,以用于术后感染的早期诊断。

连续纳入了罗马生物医学大学校园接受大型腹部手术的90例患者。入院时以及术后第1天、第2天和第3天通过时间分辨扩增镧系元素荧光免疫分析(TRACE)测定降钙素原浓度。使用曼-惠特尼检验和方差分析的ANOVA检验比较降钙素原水平。进行受试者工作特征(ROC)分析以确定降钙素原在术后感染情况下的诊断能力。

发生或未发生术后感染的患者之间降钙素原值存在显著差异。术后第1天或第2天降钙素原>1.0 ng/mL以及第3天>0.5 ng/mL可诊断为感染性并发症,而术后第5天降钙素原<0.5 ng/mL有助于患者早期安全出院。

总之,每日测量降钙素原可能是一种有用的诊断工具,可改善大型腹部手术后的术后医疗护理,应予以推荐。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6413/5779742/5cfcd87d5f80/medi-97-e9496-g004.jpg

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