重症监护病房中感染标志物作为菌血症预测指标的前瞻性研究。

Infection markers as predictors of Bacteremia in an Intensive Care Unit: A prospective study.

作者信息

Sen Pinar, Demirdal Tuna, Nemli Salih Atakan, Vardar Ilknur, Kizilkaya Mehmet, Sencan Atilla, Yilmaz Huriye Erbak

机构信息

Pinar Sen, M.D. Department of Infectious Diseases and Clinical Microbiology Izmir Katip Celebi University Ataturk Training and Research Hospital, Katip Celebi University Ataturk Research and Training Hospital 35360, Karabaglar, Izmir, Turkey.

Prof. Tuna Demirdal, Department of Infectious Diseases and Clinical Microbiology Izmir Katip Celebi University Ataturk Training and Research Hospital, Katip Celebi University Ataturk Research and Training Hospital 35360, Karabaglar, Izmir, Turkey.

出版信息

Pak J Med Sci. 2018 Nov-Dec;34(6):1517-1524. doi: 10.12669/pjms.346.15665.

DOI:10.12669/pjms.346.15665

PMID:30559815

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6290214/

Abstract

OBJECTIVE

Although several biomarkers have been evaluated for the diagnosis and prognosis of sepsis, the gold standard biomarker has not yet been found. We aimed to evaluate the diagnostic value of neutrophil-to-lymphocyte count ratio (NLCR), neopterin, pro-adrenomedullin (pro-ADM) and the other infection markers to predict bacteremia in patients with SIRS, sepsis and severe sepsis/septic shock.

METHODS

A prospective cohort study was conducted on septic patients in a tertiary referral hospital between December 2014- July 2015. A total of 156 patients diagnosed with SIRS, sepsis and severe sepsis/septic shock in Anesthesia intensive care unit (ICU) were included in the study.

RESULTS

A total of 156 patients who had been diagnosed as SIRS(10.9%), sepsis (44.2%) and severe sepsis/septic shock (44.9%) were included. Positive blood cultures were obtained in 64 patients. NLCR, neopterin and pro-ADM levels were insignificant in predicting bacteremia (p>0.05). The mortality rate was significantly higher in bacteremic sepsis (43.9%) compared to non-bacteremic patients (20.8%) (p=0.001). Only procalcitonin levels were significant predictor of mortality (p<0.001).

CONCLUSION

NLCR, CRP, procalcitonin, neopterin and pro-ADM levels were insignificant in diagnosis of bacteremia in critically ill patients. The gold standard method in predicting bacteremia is still blood culture positivity.

摘要

目的

尽管已经评估了多种生物标志物用于脓毒症的诊断和预后，但尚未找到金标准生物标志物。我们旨在评估中性粒细胞与淋巴细胞计数比值（NLCR）、蝶呤、前肾上腺髓质素（pro-ADM）及其他感染标志物对预测全身炎症反应综合征（SIRS）、脓毒症和严重脓毒症/脓毒性休克患者菌血症的诊断价值。

方法

2014年12月至2015年7月在一家三级转诊医院对脓毒症患者进行了一项前瞻性队列研究。本研究纳入了麻醉重症监护病房（ICU）中156例诊断为SIRS、脓毒症和严重脓毒症/脓毒性休克的患者。

结果

共纳入156例诊断为SIRS（10.9%）、脓毒症（44.2%）和严重脓毒症/脓毒性休克（44.9%）的患者。64例患者血培养阳性。NLCR、蝶呤和pro-ADM水平在预测菌血症方面无统计学意义（p>0.05）。菌血症性脓毒症患者的死亡率（43.9%）显著高于非菌血症患者（20.8%）（p=0.001）。只有降钙素原水平是死亡率的显著预测指标（p<0.001）。