血清降钙素原作为血液恶性肿瘤发热患者菌血症的独立诊断标志物。
Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies.
机构信息
Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
出版信息
PLoS One. 2019 Dec 10;14(12):e0225765. doi: 10.1371/journal.pone.0225765. eCollection 2019.
BACKGROUND
Serum procalcitonin (PCT) and C-reactive protein (CRP) are biomarkers of infection. In patients with hematologic disorders with or without hematopoietic stem cell transplantation (HSCT), it is difficult to distinguish bloodstream infections from aseptic causes of febrile episodes. The objective of this study was to investigate diagnostic values of PCT and CRP in predicting systemic bacterial infection in patients with hematologic malignancies.
METHODS
Clinical and laboratory data of 614 febrile episode cases from 511 patients were analyzed. Febrile episodes were classified into four groups: (1) culture-positive bacterial infection by Gram-positive cocci (GPC), (2) culture-positive bacterial infection by Gram-negative bacilli (GNB), (3) fungal infection, and (4) viral infection or a noninfectious etiology.
RESULTS
Of 614 febrile cases, systemic bacterial infections were confirmed in 99 (16.1%) febrile episodes, including 38 (6.2%) GPC and 61 (9.9%) GNB infections. PCT levels were significantly higher in GNB infectious episodes than those in febrile episodes caused by fungal infection (0.58 ng/mL (95% CI: 0.26-1.61) vs. 0.22 ng/mL (0.16-0.38), P = 0.047). Bacterial infectious episodes showed higher PCT and CRP levels than non-bacterial events (PCT: 0.49 (0.26-0.93) ng/mL vs. 0.20 (0.18-0.22) ng/mL, P < 0.001; CRP: 76.6 (50.5-92.8) mg/L vs. 58.0 (51.1-66.5) mg/L, P = 0.036). For non-neutropenic febrile episodes, both PCT and CRP discriminated bacteremia from non-bacteremia. However, in neutropenic febrile episodes, PCT only distinguished bacteremia from non-bacteremia. In non-neutropenic episode, both PCT and CRP showed good diagnostic accuracy (AUC: 0.757 vs. 0.763). In febrile neutropenia, only PCT discriminated bacteremia from non-bacterial infection (AUC: 0.624) whereas CRP could not detect bacteremia (AUC: 0.500, 95% CI: 0.439-0.561, P > 0.05).
CONCLUSIONS
In this single-center observational study, PCT was more valuable than CRP for discriminating between bacteremia and non-bacteremia independent of neutropenia or HSCT.
背景
降钙素原（PCT）和 C 反应蛋白（CRP）是感染的生物标志物。在患有血液系统疾病的患者中，无论是否接受造血干细胞移植（HSCT），都很难区分血流感染和发热的无菌原因。本研究的目的是探讨 PCT 和 CRP 在预测血液系统恶性肿瘤患者全身细菌感染中的诊断价值。
方法
分析了 511 例患者的 614 例发热发作病例的临床和实验室数据。发热发作分为四组：（1）革兰阳性球菌（GPC）培养阳性的细菌感染，（2）革兰阴性杆菌（GNB）培养阳性的细菌感染，（3）真菌感染，（4）病毒感染或非感染性病因。
结果
在 614 例发热病例中，99 例（16.1%）发热病例确诊为全身细菌感染，其中 38 例（6.2%）为 GPC 感染，61 例（9.9%）为 GNB 感染。GNB 感染的 PCT 水平明显高于真菌感染的发热发作（0.58ng/mL（95%CI：0.26-1.61）vs.0.22ng/mL（0.16-0.38），P=0.047）。细菌感染发作的 PCT 和 CRP 水平高于非细菌事件（PCT：0.49（0.26-0.93）ng/mL vs.0.20（0.18-0.22）ng/mL，P<0.001；CRP：76.6（50.5-92.8）mg/L vs.58.0（51.1-66.5）mg/L，P=0.036）。对于非中性粒细胞减少性发热发作，PCT 和 CRP 均能区分菌血症和非菌血症。然而，在中性粒细胞减少性发热发作中，只有 PCT 能区分菌血症和非菌血症。在非中性粒细胞减少性发作中，PCT 和 CRP 均具有良好的诊断准确性（AUC：0.757 对 0.763）。在发热性中性粒细胞减少症中，只有 PCT 能区分菌血症和非细菌感染（AUC：0.624），而 CRP 无法检测到菌血症（AUC：0.500，95%CI：0.439-0.561，P>0.05）。
结论
在这项单中心观察性研究中，PCT 比 CRP 更有价值，可用于区分中性粒细胞减少或 HSCT 患者的菌血症和非菌血症。
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