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降钙素原、C反应蛋白、白蛋白及血培养作为脓毒症诊断的早期标志物或预后预测指标:一项前瞻性分析

Procalcitonin, C-Reactive Protein, Albumin, and Blood Cultures as Early Markers of Sepsis Diagnosis or Predictors of Outcome: A Prospective Analysis.

作者信息

Schmidt de Oliveira-Netto Ana Cristina, Morello Luis G, Dalla-Costa Libera M, Petterle Ricardo R, Fontana Rafael M, Conte Danieli, Pereira Luciane A, Raboni Sonia M

机构信息

Postgraduate Program in Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, Brazil.

Instituto de Biologia Molecular do Paraná, Curitiba, Brazil.

出版信息

Clin Pathol. 2019 Jun 18;12:2632010X19847673. doi: 10.1177/2632010X19847673. eCollection 2019 Jan-Dec.

Abstract

PURPOSE

Sepsis is a condition with high mortality rates and its diagnosis remains a challenge. We assessed epidemiological, clinical data, multiple biomarker profiles, and blood culture with respect to sepsis diagnosis and predictors of outcome.

METHODS

In total, 183 patients who were suspected of having sepsis and underwent blood culture collection were followed up for 7 days. Sepsis-related Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated daily; biomarkers and blood culture test results were evaluated.

RESULTS

In total, 78 (43%) had sepsis, 50 (27%) had septic shock, and 55 (30%) had no sepsis. Blood culture was positive in 28% and 42% of the sepsis and septic shock groups, respectively ( < .001). Regarding clinical profiles and biomarker values, there were no differences between the sepsis and non-sepsis groups, but significant differences were observed in the septic shock group. Multivariate logistic regression models revealed that age, serum albumin level, APACHE II, and SOFA 1 day scores were the independent variables for death.

CONCLUSIONS

The challenge in the diagnosis of sepsis continues as clinical and laboratory differences found between the groups were due to septic shock. Older aged patients with lower albumin levels and higher APACHE II and SOFA 1 day scores have a greater probability of mortality.

摘要

目的

脓毒症是一种死亡率很高的疾病,其诊断仍然是一项挑战。我们评估了脓毒症诊断及预后预测因素方面的流行病学、临床数据、多种生物标志物谱以及血培养情况。

方法

总共183例疑似脓毒症并接受血培养采集的患者进行了7天的随访。每天计算脓毒症相关器官功能衰竭评估(SOFA)和急性生理与慢性健康状况评估(APACHE)II评分;评估生物标志物和血培养检测结果。

结果

总共78例(43%)患有脓毒症,50例(27%)患有脓毒性休克,55例(30%)没有脓毒症。脓毒症组和脓毒性休克组血培养阳性率分别为28%和42%(<0.001)。关于临床特征和生物标志物值,脓毒症组和非脓毒症组之间没有差异,但在脓毒性休克组中观察到显著差异。多因素逻辑回归模型显示,年龄、血清白蛋白水平、APACHE II评分和第1天SOFA评分是死亡的独立变量。

结论

由于各组之间发现的临床和实验室差异是由脓毒性休克导致的,脓毒症诊断方面的挑战依然存在。白蛋白水平较低、APACHE II评分和第1天SOFA评分较高的老年患者死亡概率更大。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7f82/6582287/0386153da48b/10.1177_2632010X19847673-fig1.jpg

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