Durrance Richard J, Ullah Tofura, Patel Harsh, Martinez Grace, Cervellione Kelly, Zafonte Veronica B, Gafoor Khalid, Bagheri Farshad
Division of Pulmonary and Critical Care, Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, Elmhurst, NY, USA.
Department of Clinical Research, Jamaica Hospital Medical Center, Richmond Hill, NY, USA.
Biomark Insights. 2020 May 15;15:1177271920917941. doi: 10.1177/1177271920917941. eCollection 2020.
Bacteremia and sepsis are significant contributors to the morbidity, mortality, and economic burden of health care systems worldwide. Procalcitonin has been identified as a potentially useful marker of disease and severity in sepsis. However, the assumption that greater procalcitonin levels correlate with greater burden of disease has not been adequately studied.
A retrospective chart review of adult patients admitted to an urban teaching hospital with suspected sepsis was undertaken to test the association of elevated procalcitonin (>30 ng/mL) with other markers of sepsis (lactic acid, white blood cell count, percent bands), severity of disease (Sequential Organ Failure Assessment [SOFA] and Acute Physiology and Chronic Health Evaluation-II [APACHE II] scores), and mortality.
In total, 168 patients were identified over 18 months (42% ward, 11% Stepdown, 44% medical intensive care unit [MICU], 2% surgical intensive care unit (STICU), 1% gynecology [GYN]). The Spearman correlation analysis showed that serum procalcitonin level did not correlate with SOFA ( = .238) or APACHE II ( = .918) scores on admission, and did not correlate with survival (Kruskal-Wallis test, = .937). However, higher serum procalcitonin levels were associated with patients who had positive blood cultures (Kruskal-Wallis test, = .0016 for Gram-positive and = .0007 for Gram-negative bacteria). Lactic acid levels on admission strongly correlated with SOFA APACHE II (the Spearman correlation, < .0001 for both) and mortality ( = .0001 for both).
Higher serum procalcitonin levels above 30 ng/mL failed to correlate with indicators of sepsis, severity of disease (SOFA and APACHE II scores), and mortality but were associated with positive blood cultures. Lactic acid levels did show correlation to both severity of disease and mortality. Serum procalcitonin levels >30 ng/mL do not appear to correlate with the severity of disease in a sample of patients with markedly elevated initial procalcitonin levels.
菌血症和脓毒症是全球医疗保健系统发病、死亡及经济负担的重要因素。降钙素原已被确定为脓毒症中疾病和严重程度的一个潜在有用标志物。然而，降钙素原水平越高与疾病负担越重相关这一假设尚未得到充分研究。
对一家城市教学医院收治的疑似脓毒症成年患者进行回顾性病历审查，以检验降钙素原升高（>30 ng/mL）与脓毒症的其他标志物（乳酸、白细胞计数、杆状核百分比）、疾病严重程度（序贯器官衰竭评估[SOFA]和急性生理与慢性健康状况评估-II[APACHE II]评分）及死亡率之间的关联。
在18个月期间共识别出168例患者（42%在病房，11%在逐步降级病房，44%在医学重症监护病房[MICU]，2%在外科重症监护病房[STICU]，1%在妇科[GYN]）。Spearman相关性分析显示，血清降钙素原水平与入院时的SOFA（ρ = 0.238）或APACHE II（ρ = 0.918）评分无关，也与生存率无关（Kruskal-Wallis检验，ρ = 0.937）。然而，血清降钙素原水平较高与血培养阳性的患者相关（Kruskal-Wallis检验，革兰氏阳性菌ρ = 0.0016，革兰氏阴性菌ρ = 0.0007）。入院时的乳酸水平与SOFA、APACHE II评分（Spearman相关性，两者均<0.0001）及死亡率（两者均ρ = 0.0001）密切相关。
血清降钙素原水平高于30 ng/mL与脓毒症指标、疾病严重程度（SOFA和APACHE II评分）及死亡率无关，但与血培养阳性相关。乳酸水平确实与疾病严重程度和死亡率均相关。在初始降钙素原水平显著升高的患者样本中，血清降钙素原水平>30 ng/mL似乎与疾病严重程度无关。
