Section of Endocrine Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
J Clin Endocrinol Metab. 2019 Dec 1;104(12):5915-5922. doi: 10.1210/jc.2019-01082.
Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis.
To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism.
This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018. Quick Sequential Organ Failure Assessment score ≥ 2 or positive bacterial cultures identified bacterial sepsis, and a mean arterial pressure less than 65 mm Hg or a vasopressor requirement defined septic shock. Sensitivity and specificity of PCT for evaluation of bacterial sepsis and septic shock were measured.
We identified 217 euthyroid patients, 197 patients with MH, and 84 patients with TT. Bacterial sepsis was found in 98 (45.2%), 92 (46.7%), and 36 (42.9%) of these patients, respectively (P > 0.05). Septic shock was identified in 13 (6.0%), 13 (6.6%), and 5 (6.0%) patients (P > 0.05), respectively. With use of a PCT cutoff of 0.5 µg/L for bacterial sepsis, the sensitivity was 59%, 61%, and 53% (P > 0.05) and specificity was 81%, 77%, and 81% (P > 0.05) for the diagnosis of bacterial sepsis in euthyroid, MH, and TT patients, respectively. With use of a PCT cutoff of 2.0 µg/L for septic shock, the sensitivity was 46%, 62%, and 63% (P > 0.05) and specificity was 86%, 82%, and 91% (P > 0.05) for the diagnosis of septic shock in these patients, respectively.
Despite the thyroidal origin of PCT, hypothyroidism did not affect the diagnostic performance of serum PCT levels in predicting bacterial sepsis or septic shock.
降钙素原（PCT）是甲状腺 C 细胞在生理条件下产生的一种蛋白质，在脓毒症中其血清水平升高。
评估血清 PCT 对预测甲状腺功能减退症患者与甲状腺功能正常患者细菌脓毒症和感染性休克的诊断性能。
本回顾性研究评估了 2005 年至 2018 年期间从一个前瞻性维护的数据库中确定的无甲状腺功能障碍（甲状腺功能正常）、原发性甲状腺功能减退症（药物性甲状腺功能减退症，MH）和甲状腺全切除术后（TT）的甲状腺功能减退症患者的 PCT 检测结果。序贯器官衰竭评估评分≥2 或阳性细菌培养确定为细菌脓毒症，平均动脉压<65mmHg 或需要血管加压药定义为感染性休克。测量 PCT 对细菌脓毒症和感染性休克评估的敏感性和特异性。
共纳入 217 例甲状腺功能正常患者、197 例 MH 患者和 84 例 TT 患者。这些患者中分别有 98（45.2%）、92（46.7%）和 36（42.9%）例患者发生细菌脓毒症（P>0.05）。分别有 13（6.0%）、13（6.6%）和 5（6.0%）例患者发生感染性休克（P>0.05）。使用 0.5μg/L 的 PCT 截断值诊断细菌脓毒症，甲状腺功能正常、MH 和 TT 患者的诊断敏感性分别为 59%、61%和 53%（P>0.05），特异性分别为 81%、77%和 81%（P>0.05）。使用 2.0μg/L 的 PCT 截断值诊断感染性休克，甲状腺功能正常、MH 和 TT 患者的诊断敏感性分别为 46%、62%和 63%（P>0.05），特异性分别为 86%、82%和 91%（P>0.05）。
尽管 PCT 来源于甲状腺，但甲状腺功能减退症并不影响血清 PCT 水平对预测细菌脓毒症或感染性休克的诊断性能。
