降钙素原作为血液系统恶性肿瘤伴发热性中性粒细胞减少患者革兰阴性菌血流感染的标志物。
Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia.
机构信息
Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital , Fuzhou , China.
Laboratory Department, Fujian Medical University Union Hospital , Fuzhou , China.
出版信息
Leuk Lymphoma. 2019 Oct;60(10):2441-2448. doi: 10.1080/10428194.2019.1581928. Epub 2019 Feb 26.
The aim of this study was to explore the predictive value of procalcitonin (PCT) in Gram-negative bloodstream infections (BSIs) in hematological patients with febrile neutropenia. A total of 1466 samples (396 blood culture (BC)-positive, 1052 BC-negative, and 18 contaminated specimens) were included, comprising 268 Gram-negative, 88 Gram-positive, 19 fungal, and 21 polymicrobial BSIs. Median PCT value (0.72 ng/mL; IQR: 0.23-3.87) was significantly higher in Gram-negative than Gram-positive (0.34 ng/mL; IQR: 0.14-2.23; < .01), or fungal (0.27 ng/mL; IQR: 0.13-0.40; < .01) BSIs. In mono-microbial BSIs, the best PCT cutoff distinguishing Gram-negative BSIs from all other fever causes was 0.56 ng/ml, with a specificity of 76.8%. PCT levels were significantly higher in BSIs from multidrug-resistant (MDR) Gram-negative strains than from non-MDR .01). This study confirms that elevated PCT may predict Gram-negative BSIs in hematological patients with febrile neutropenia, and demonstrates higher PCT levels in MDR Gram-negative BSIs in these patients.
本研究旨在探讨降钙素原（PCT）在中性粒细胞减少性发热血液病患者革兰氏阴性菌血流感染（BSI）中的预测价值。共纳入 1466 份样本（396 份血培养（BC）阳性、1052 份 BC 阴性和 18 份污染标本），包括 268 份革兰氏阴性菌、88 份革兰氏阳性菌、19 份真菌和 21 份混合微生物 BSIs。革兰氏阴性菌与革兰氏阳性菌（0.34ng/ml；IQR：0.14-2.23；P<.01）或真菌（0.27ng/ml；IQR：0.13-0.40；P<.01）BSIs 的 PCT 值中位数（0.72ng/ml；IQR：0.23-3.87）显著更高。在单微生物 BSI 中，区分革兰氏阴性菌 BSI 与所有其他发热原因的最佳 PCT 截断值为 0.56ng/ml，特异性为 76.8%。耐多药（MDR）革兰氏阴性菌 BSI 的 PCT 水平明显高于非 MDR 革兰氏阴性菌（P<.01）。本研究证实，在中性粒细胞减少性发热血液病患者中，PCT 升高可能预测革兰氏阴性菌 BSI，并表明这些患者中 MDR 革兰氏阴性菌 BSI 的 PCT 水平更高。
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