血清降钙素原、C反应蛋白浓度及临床肺部感染评分对呼吸机相关性肺炎的诊断效能

Diagnostic efficacy of serum procalcitonin, C-reactive protein concentration and clinical pulmonary infection score in Ventilator-Associated Pneumonia.

作者信息

Chen Changqin, Yan Molei, Hu Caibao, Lv Xiaochun, Zhang Huihui, Chen Shangzhong

机构信息

Department of ICU, Zhejiang Hospital. No 12. Lingyin Road, Hangzhou City, Zhejiang Province, 317000 PR China.

出版信息

Med Sci (Paris). 2018 Oct;34 Focus issue F1:26-32. doi: 10.1051/medsci/201834f105. Epub 2018 Nov 7.

DOI:10.1051/medsci/201834f105

PMID:30403171

Abstract

OBJECTIVE

The aim of this study was to evaluate the diagnostic efficacy of serum procalcitonin (PCT), c-reactive protein (CRP) concentration and clinical pulmonary infection score(CPIS) in ventilator-associated pneumonia(VAP).

METHODS

Forty-nine patients who were admitted to the intensive care unit (ICU) of Zhejiang Hospital with suspected VAP were recruited in this study. The serum level of PCT and CRP of all patients were measured and CPIS was calculated at the time of VAP suspected diagnosis. Of the included 49 patients, 24 were finally confirmed of VAP by microbiology assay. And the other 25 patients were considered as clinical suspected VAP without microbiology confirmation. The diagnostic sensitivity, specificity and area under the receiver operating characteristic (ROC) curve (AUC) were calculated using the serum PCT, CRP concentration and CPIS. The correlation among serum PCT, CRP concentration and CPIS were also evaluated by Spearson correlation test.

RESULTS

A total of 100 bronchoscopic aspiration sputum specimen were examined in bacterial culture. 30 samples were found with suspected pathogenic bacteria. Six samples were found with 2 types of suspected pathogenic bacteria. PCT serum concentration and CPIS score were significantly different (P<0.05) between the patient group [1.4 (0.68 ∼ 2.24), 6.0 (4.25 ∼ 8.00)] and the control group [0.4 (0.17 ∼ 1.39), 3.0 (1.00 ∼ 5.00)] ; However, the serum CRP [102.8(66.75 ∼ 130.90) vs 86.1(66.95 ∼ 110.10)] was not statistically different between the two groups (P>0.05). A significant correlation was found between serum PCT and CRP concentrations (r=0.55, P<0.01), but not between PCT vs CPIS and CRP vs CPIS (p>0.05). The diagnostic sensitivity, specificity and AUC were 72.0%, 75.0%, 0.81 (0.69 ∼ 0.93) for CPIS; 60.0%, 87.5%, 0.76 (0.62 ∼ 0.90) for PCT and 68.0%, 58.3%, 0.59 (0.43 ∼ 0.76) for CRP.

CONCLUSION

PCT serum level and CPIS score are elevated in VAP patients and could therefore represent potential biomarkers for VAP early diagnosis.

摘要

目的

本研究旨在评估血清降钙素原（PCT）、C反应蛋白（CRP）浓度及临床肺部感染评分（CPIS）在呼吸机相关性肺炎（VAP）中的诊断效能。

方法

本研究纳入了49例入住浙江大学医学院附属第一医院重症监护病房（ICU）且疑似VAP的患者。在疑似VAP诊断时，检测所有患者的血清PCT和CRP水平，并计算CPIS。在纳入的49例患者中，24例最终通过微生物学检测确诊为VAP。另外25例患者被视为临床疑似VAP但未经微生物学确认。使用血清PCT、CRP浓度和CPIS计算诊断敏感性、特异性及受试者操作特征曲线（ROC）下面积（AUC）。还通过Spearson相关性检验评估血清PCT、CRP浓度和CPIS之间的相关性。

结果

共对100份支气管镜吸痰标本进行细菌培养检查。发现30份标本有疑似病原菌。6份标本发现有2种疑似病原菌。患者组[1.4（0.68～2.24），6.0（4.25～8.00）]与对照组[0.4（0.17～1.39），3.0（1.00～5.00）]之间的PCT血清浓度和CPIS评分差异有统计学意义（P<0.05）；然而，两组间血清CRP[102.8（66.75～130.90）对86.1（66.95～110.10）]差异无统计学意义（P>0.05）。血清PCT与CRP浓度之间存在显著相关性（r=0.55，P<0.01），但PCT与CPIS、CRP与CPIS之间无相关性（P>0.05）。CPIS的诊断敏感性、特异性和AUC分别为72.0%、75.0%、0.81（0.69～0.93）；PCT分别为60.0%、87.5%、0.76（0.62～0.90）；CRP分别为68.0%、58.3%、0.59（0.43～0.76）。