Affiliated Hangzhou First People's Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Clinical Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Mediators Inflamm. 2020 May 15;2020:8203813. doi: 10.1155/2020/8203813. eCollection 2020.
Sepsis is a common complication of acute cholangitis (AC), which is associated with a high mortality rate. Our study is aimed at exploring the significance of white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), and temperature (T) alone or combined together in early identification and curative effect monitoring of AC with or without sepsis.
65 consecutive cases with AC and 76 control cases were enrolled. They were divided into three groups: Group A (AC with sepsis), Group B (AC without sepsis), and Group C (inpatients without AC or other infections). The levels of WBC, CRP, PCT, sTREM-1, and temperature were measured dynamically. The study was carried out and reported according to STARD 2015 reporting guidelines.
CRP had the highest AUC to identify AC from individuals without AC or other infections (AUC 1.000, sensitivity 100.0%, specificity 100.0%, positive predictive value 100.0%, and negative predictive value 100.0%). Among various single indexes, PCT performed best (AUC 0.785, sensitivity 75.8%, specificity 72.2%, positive predictive value 68.7%, and negative predictive value 78.8%) to distinguish sepsis with AC, while different combinations of indexes did not perform better. From day 1 to day 5 of hospitalization, the levels of sTREM-1 in Group A were the highest, followed by Groups B and C ( < 0.05); on day 8, sTREM-1 levels in Groups A and B declined back to normal. However, other index levels among three groups still had a significant difference on day 10. Both in Groups A and B, sTREM-1 levels declined fast between day 1 and day 2 ( < 0.05).
CRP is the best biomarker to suggest infection here. PCT alone is sufficient enough to diagnose sepsis with AC. sTREM-1 is the best biomarker to monitor patients' response to antimicrobial therapy and biliary drainage.
脓毒症是急性胆管炎（AC）的常见并发症，与高死亡率相关。我们的研究旨在探讨白细胞（WBC）、C 反应蛋白（CRP）、降钙素原（PCT）、髓系细胞触发受体-1 可溶性（sTREM-1）和温度（T）单独或联合用于早期识别和监测有无合并脓毒症的 AC 的意义。
连续纳入 65 例 AC 患者和 76 例对照患者，分为 A 组（AC 合并脓毒症）、B 组（AC 无脓毒症）和 C 组（无 AC 或其他感染的住院患者）。动态检测 WBC、CRP、PCT、sTREM-1 和 T 水平。本研究根据 STARD 2015 报告指南进行和报告。
CRP 对识别无 AC 或其他感染个体的 AC 具有最高 AUC（AUC 1.000，灵敏度 100.0%，特异性 100.0%，阳性预测值 100.0%，阴性预测值 100.0%）。在各种单项指标中，PCT 对区分 AC 合并脓毒症的效果最佳（AUC 0.785，灵敏度 75.8%，特异性 72.2%，阳性预测值 68.7%，阴性预测值 78.8%），而不同指标组合的效果并未更好。从住院第 1 天到第 5 天，A 组 sTREM-1 水平最高，其次是 B 组和 C 组（<0.05）；第 8 天，A 组和 B 组的 sTREM-1 水平恢复正常。然而，第 10 天三组之间其他指标水平仍有显著差异。A 组和 B 组 sTREM-1 水平在第 1 天和第 2 天之间下降较快（<0.05）。
CRP 是提示感染的最佳生物标志物。PCT 单独足以诊断 AC 合并脓毒症。sTREM-1 是监测患者对抗菌治疗和胆道引流反应的最佳生物标志物。
