Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Republic of Korea.
Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Republic of Korea.
Am J Emerg Med. 2019 Feb;37(2):272-276. doi: 10.1016/j.ajem.2018.05.047. Epub 2018 May 26.
The recent definition of sepsis was modified based on a scoring system focused on organ failure (Sepsis-3). It would be a time-consuming process to detect the sepsis patient using Sepsis-3. Procalcitonin (PCT) is a well-known biomarker for diagnosing sepsis/septic shock and monitoring the efficacy of treatment. We conducted a study to verify the predictability of PCT for diagnosing sepsis based on Sepsis-3 definition.
MATERIALS & METHODS: This is a retrospective cohort study. The patients whose PCT was measured on the emergency department (ED) arrival and had final diagnosis related infection were enrolled. The patients were categorized by infection, sepsis, or septic shock followed by Sepsis-3 definition. "Pre-septic shock" was defined when a patient was initially diagnosed with sepsis, following which his/her mean arterial blood pressure decreased to under 65 mmHg refractory to fluid resuscitation and there was need for vasopressor use during ED admission. Receiver operating characteristics (ROC) curve and area under the curve (AUC) analysis were performed to verify sensitivity and specificity of PCT.
866 patients were enrolled in the final analysis. There are 287 cases of infection, 470 cases of sepsis, and 109 cases of septic shock. An optimal cutoff value for diagnosing sepsis was 0.41 ng/dL (sensitivity: 74.8% and specificity: 63.8%; AUC: 0745), septic shock was 4.7 ng/dL (sensitivity: 66.1% and specificity: 79.0%; AUC: 0.784), and "pre-septic shock" was 2.48 ng/dL (sensitivity: 72.8%, specificity: 72.8%, AUC: 0.781), respectively.
PCT is a reliable biomarker to predict sepsis or septic shock according to the Sepsis-3 definitions.
最近的脓毒症定义是基于器官衰竭评分系统（Sepsis-3）修改的。使用 Sepsis-3 来检测脓毒症患者将是一个耗时的过程。降钙素原（PCT）是诊断脓毒症/脓毒性休克和监测治疗效果的知名生物标志物。我们进行了一项研究，以验证 PCT 根据 Sepsis-3 定义诊断脓毒症的预测能力。
这是一项回顾性队列研究。纳入了在急诊科（ED）就诊时测量 PCT 且最终诊断为感染相关的患者。根据感染、脓毒症或脓毒性休克以及随后的 Sepsis-3 定义对患者进行分类。当患者最初被诊断为脓毒症，其平均动脉压随后降至 65mmHg 以下，对液体复苏无反应，并且在 ED 入院期间需要使用升压药时，定义为“脓毒性休克前”。进行了Receiver operating characteristics（ROC）曲线和曲线下面积（AUC）分析，以验证 PCT 的敏感性和特异性。
最终分析纳入了 866 名患者。其中 287 例感染，470 例脓毒症，109 例脓毒性休克。诊断脓毒症的最佳截断值为 0.41ng/dL（敏感性：74.8%，特异性：63.8%；AUC：0.745），诊断脓毒性休克的最佳截断值为 4.7ng/dL（敏感性：66.1%，特异性：79.0%；AUC：0.784），诊断“脓毒性休克前”的最佳截断值为 2.48ng/dL（敏感性：72.8%，特异性：72.8%；AUC：0.781）。
根据 Sepsis-3 定义，PCT 是预测脓毒症或脓毒性休克的可靠生物标志物。
