Clinico-Medical Biochemistry Laboratory, Department of Biochemistry, Faculty of Sciences, University of Agriculture, Faisalabad, Pakistan.
Hemodialysis Room, Binzhou City Center Hospital, Bingzhou, China.
J Biol Regul Homeost Agents. 2018 Sep-Oct;32(5):1165-1169.
Sepsis, a systemic inflammatory response syndrome induced by infection, has high rates of morbidity and mortality. Pneumonia is a major cause for sepsis; however, pneumonia complicated by sepsis is a difficult clinical diagnosis. To assess the clinical relevance of serum procalcitonin (PCT) and hypersensitive C-reactive protein (hs-CRP) in early diagnosis of pneumonia complicated by sepsis, 220 patients with pneumonia who were admitted to hospital from July 2015 to July 2016 were enrolled in this study. The patients were divided into non-sepsis (N=82), mild sepsis (N=97), severe sepsis (N=23), and septic shock (N=18) groups. The patients were also divided into a survival group (N=186) and a death group (N=34) according to their prognosis at 2 weeks. The PCT and hs-CRP levels and Acute Physiology and Chronic Health Evaluation-II (APACHE-II) scores of the two groups were evaluated. The PCT level and APACHE-II score showed a progressively increasing tendency in the non-sepsis, mild sepsis, severe sepsis, and septic shock group; the differences between all pairs of groups were significant (P less than 0.05). The hs-CRP level was significantly lower in the non-sepsis group than in the other groups (P less than 0.05), but differences among the other groups were not significant (P>0.05). The areas under the receiver operating characteristic curves of PCT and hs-CRP for diagnosis of pneumonia complicated by mild and severe sepsis were 0.841 and 0.817, respectively. The optimal cut-off points for pneumonia and sepsis were ≥0.5 ng/mL and ≥55 mg/L, respectively; the sensitivity and specificity were 71.42% and 82.13%, and 75.04% and 53.61%, respectively. The sensitivity and specificity of diagnosis based on PCT and hs-CRP were 89.32% and 85.68%, respectively. PCT and hs-CRP are used to assess the severity of pneumonia in combination with sepsis in new-borns, but PCT is more strongly related to the severity of sepsis than is hs-CRP. Detection of PCT in combination with hs-CRP facilitates the early diagnosis of pneumonia and sepsis in new-borns, as well as monitoring of the treatment response and prediction of the prognosis.
脓毒症是一种由感染引起的全身炎症反应综合征，其发病率和死亡率都很高。肺炎是导致脓毒症的主要原因；然而，肺炎并发脓毒症是一种临床诊断困难的疾病。为了评估血清降钙素原（PCT）和超敏 C 反应蛋白（hs-CRP）在肺炎并发脓毒症早期诊断中的临床相关性，本研究纳入了 2015 年 7 月至 2016 年 7 月期间因肺炎住院的 220 例患者。这些患者被分为非脓毒症组（N=82）、轻度脓毒症组（N=97）、重度脓毒症组（N=23）和脓毒性休克组（N=18）。根据 2 周后的预后，患者还被分为存活组（N=186）和死亡组（N=34）。评估了两组患者的 PCT 和 hs-CRP 水平及急性生理学与慢性健康状况评分系统 II（APACHE-II）评分。PCT 水平和 APACHE-II 评分在非脓毒症、轻度脓毒症、重度脓毒症和脓毒性休克组中呈逐渐升高趋势；各组间差异均有统计学意义（P<0.05）。非脓毒症组的 hs-CRP 水平明显低于其他组（P<0.05），但其他组间差异无统计学意义（P>0.05）。PCT 和 hs-CRP 对诊断轻度和重度脓毒症性肺炎的受试者工作特征曲线下面积分别为 0.841 和 0.817。肺炎和脓毒症的最佳截断值分别为≥0.5ng/ml 和≥55mg/L；其敏感性和特异性分别为 71.42%和 82.13%，75.04%和 53.61%。基于 PCT 和 hs-CRP 的诊断敏感性和特异性分别为 89.32%和 85.68%。PCT 和 hs-CRP 联合用于评估新生儿肺炎合并脓毒症的严重程度，但 PCT 与脓毒症的严重程度相关性强于 hs-CRP。联合检测 PCT 和 hs-CRP 有助于早期诊断新生儿肺炎和脓毒症，监测治疗反应，预测预后。
