Clinical Pharmacy Department, Faculty of Pharmacy, MTI University, Cairo, Egypt.
Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt.
Ir J Med Sci. 2021 Nov;190(4):1487-1495. doi: 10.1007/s11845-020-02494-y. Epub 2021 Jan 14.
Procalcitonin (PCT) and C-reactive protein (CRP) are the main used biomarkers for sepsis and in guiding antibiotic therapy, although PCT high cost limits its use in developing countries.
Comparing between PCT and CRP in assessing severity of sepsis and in guiding antibacterial therapy in critically ill patients.
In a prospective randomized study, 60 patients were included from an Egyptian Intensive Care Unit. Patients were divided into CRP and PCT groups. CRP and PCT were measured at baseline and on days 4 and 7. Validity, sensitivity, and specificity of both biomarkers and their correlation with sepsis scores (Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sepsis-related Organ Failure Assessment (SOFA)) were evaluated. Antibacterial continuation at days 4 and 7 was assessed.
The diagnostic accuracy, specificity, and sensitivity of PCT were higher than CRP (80.79% vs 69.45%, 36% vs 28.7%, 87.6% vs 72.4%, respectively). PCT levels were significantly correlated with APACHE II score (P ≤ 0.0001) and SOFA score (P = 0.005), while CRP levels were not correlated with APACHEII and SOFA scores,(P > 0.05). PCT was associated with less antibacterial exposure (33% stopped their antibiotics on day 4 versus 6% in CRP, P = 0.009). Only 33% continued their antibacterial regimen in PCT group after 7 days versus 83% in CRP group (*P ≤ 0.0001).
PCT is a more accurate diagnostic and prognostic biomarker than CRP in patients with sepsis. PCT significantly shortened patients' exposure to antibacterial therapy and hospital length of stay.
降钙素原（PCT）和 C 反应蛋白（CRP）是脓毒症的主要生物标志物，用于指导抗生素治疗，尽管 PCT 成本较高，限制了其在发展中国家的应用。
比较 PCT 和 CRP 在评估脓毒症严重程度和指导危重症患者抗菌治疗中的作用。
前瞻性随机研究纳入了来自埃及重症监护病房的 60 名患者。患者分为 CRP 组和 PCT 组。在基线和第 4 天和第 7 天测量 CRP 和 PCT。评估了两种生物标志物的有效性、灵敏度和特异性，及其与脓毒症评分（急性生理学和慢性健康评估 II（APACHE II）和脓毒症相关器官衰竭评估（SOFA））的相关性。评估第 4 天和第 7 天抗菌治疗的持续情况。
PCT 的诊断准确性、特异性和灵敏度均高于 CRP（80.79%比 69.45%，36%比 28.7%，87.6%比 72.4%）。PCT 水平与 APACHE II 评分（P ≤ 0.0001）和 SOFA 评分（P = 0.005）显著相关，而 CRP 水平与 APACHE II 和 SOFA 评分无相关性（P > 0.05）。PCT 与抗菌药物暴露减少相关（第 4 天 33%停止抗生素治疗，而 CRP 组为 6%，P = 0.009）。第 7 天，PCT 组中只有 33%继续其抗菌方案，而 CRP 组中则有 83%（*P ≤ 0.0001）。
与 CRP 相比，PCT 是脓毒症患者更准确的诊断和预后生物标志物。PCT 显著缩短了患者对抗菌治疗的暴露时间和住院时间。
