Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Portugal.
Department of Mathematics, University of Aveiro, Portugal.
J Burn Care Res. 2021 May 7;42(3):545-554. doi: 10.1093/jbcr/iraa199.
Despite continuous advances in burn care, sepsis is still the main cause of death in burn patients. Procalcitonin (PCT) has been reported as an accurate sepsis biomarker and also as a fair predictor of death. The aim of this study was to assess PCT kinetics in the first week postburn regarding sepsis diagnosis and death prognosis. Sample included 142 patients with ≥15% TBSA, admitted from January 2011 to December 2014 at Coimbra Burns Unit, Portugal. Sepsis diagnosis was done according to American Burn Association criteria. PCT range and median values in the first 7 days after burns were statistically analyzed for its potential for sepsis diagnosis and death prognosis. A subanalysis was done regarding TBSA, sex, age, and inhalation injury. First week PCT range and median were significant for sepsis diagnosis and death prognosis, but the median area under the curve was greater in the last case. TBSA influenced PCT accuracy, which was greater for TBSA less than 40% either for diagnosis or prognosis. Age was inversely related to the accuracy, being better in younger than 40 years in both cases. PCT diagnostic accuracy was not affected by sex, opposing to the prognostic one which is better in women. Inhalation injury had no effect on diagnostic accuracy, but it happens with prognostic accuracy. PCT levels' variation is related to sepsis evolution and outcome. Its median performs better than its range. Always coupled with clinical examination, monitoring PCT levels kinetics may help early sepsis detection, potentially reducing morbidity and mortality, being also useful for death prognosis.
尽管烧伤治疗不断取得进展，但脓毒症仍然是烧伤患者死亡的主要原因。降钙素原（PCT）已被报道为一种准确的脓毒症生物标志物，也是死亡的良好预测指标。本研究旨在评估烧伤后第一周 PCT 的动力学，以了解其在脓毒症诊断和死亡预测方面的作用。研究纳入了 2011 年 1 月至 2014 年 12 月期间在葡萄牙科英布拉烧伤中心接受治疗的 142 名烧伤面积≥15%TBSA 的患者。根据美国烧伤协会的标准进行脓毒症诊断。对烧伤后第 1 天至第 7 天 PCT 的范围和中位数进行了统计学分析，以评估其在脓毒症诊断和死亡预测方面的潜在价值。对 TBSA、性别、年龄和吸入性损伤进行了亚分析。第 1 周 PCT 的范围和中位数对于脓毒症诊断和死亡预测均具有统计学意义，但在后者中，曲线下面积的中位数更大。TBSA 影响 PCT 的准确性，TBSA 小于 40%时，无论是诊断还是预后，准确性都更高。年龄与准确性呈反比，40 岁以下患者的准确性更高。PCT 的诊断准确性不受性别影响，而在预后方面，女性的准确性更好。吸入性损伤对诊断准确性没有影响，但对预后准确性有影响。PCT 水平的变化与脓毒症的发生和结果有关。其中位数比范围更能反映预后。与临床检查相结合，监测 PCT 水平的动态变化可能有助于早期发现脓毒症，从而降低发病率和死亡率，对死亡预测也有帮助。
