Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
Cardio Metabolic and Endocrine Institute, North Brunswick, NJ, USA.
J Steroid Biochem Mol Biol. 2019 Oct;193:105428. doi: 10.1016/j.jsbmb.2019.105428. Epub 2019 Jul 16.
Early diagnosis of sepsis is often difficult in clinical practice, whilst it can be vital for positive patient outcomes in sepsis management. Any delay in diagnosis and treatment may lead to significant organ failure and can be associated with elevated mortality rates. Early diagnosis and effective management of sepsis can allow for prompt antibiotic therapy and a potential reduction in mortality; it can also minimize the unnecessary use of antibiotics. Furthermore, vitamin D supplementation, which is commonly used in the intensive care units to reduce mortality, may interfere with the ability to use procalcitonin (PCT) as a means of assessing clinical progression. This paper aims to explore the diagnostic and prognostic value of serum levels of PCT as an early marker of sepsis and to assess whether it can be used as a guide for using antibiotic therapy. Several serum-based biomarkers such as C-reactive protein, lactate, presepsin, and cytokines, such as interleukin-1 (IL-1), and IL-6 have been evaluated as early indicators of sepsis but none have been proven sensitive and/or specific enough to make a definitive diagnosis. Finally the potential benefits and disadvantages of using serum levels of PCT to diagnose and monitor patients with sepsis and septic shock will be briefly discussed.
在临床实践中，脓毒症的早期诊断往往较为困难，而在脓毒症的管理中，早期诊断对于积极改善患者预后至关重要。任何诊断和治疗的延迟都可能导致严重的器官衰竭，并可能与死亡率升高相关。早期诊断和有效的脓毒症管理可以实现及时的抗生素治疗，并可能降低死亡率；还可以尽量减少抗生素的不必要使用。此外，在重症监护病房中常用的维生素 D 补充剂可降低死亡率，但其可能会干扰降钙素原（PCT）作为评估临床进展的手段的作用。本文旨在探讨血清 PCT 水平作为脓毒症早期标志物的诊断和预后价值，并评估其是否可用作抗生素治疗的指导。人们已经评估了几种基于血清的生物标志物，如 C 反应蛋白、乳酸、降钙素原前肽和细胞因子（如白细胞介素-1（IL-1）和 IL-6），作为脓毒症的早期指标，但没有一种被证明具有足够的敏感性和/或特异性来做出明确的诊断。最后，将简要讨论使用血清 PCT 水平诊断和监测脓毒症和脓毒性休克患者的潜在益处和弊端。
