Daubin Cédric, Fournel François, Thiollière Fabrice, Daviaud Fabrice, Ramakers Michel, Polito Andréa, Flocard Bernard, Valette Xavier, Du Cheyron Damien, Terzi Nicolas, Fartoukh Muriel, Allouche Stephane, Parienti Jean-Jacques
Department of Medical Intensive Care, CHU de Caen, 14000, Caen, France.
Department of Biostatistics and Clinical Research, CHU de Caen, 14000, Caen, France.
Ann Intensive Care. 2021 Mar 6;11(1):39. doi: 10.1186/s13613-021-00816-6.
To assess the ability of procalcitonin (PCT) to distinguish between bacterial and nonbacterial causes of patients with severe acute exacerbation of COPD (AECOPD) admitted to the ICU, we conducted a retrospective analysis of two prospective studies including 375 patients with severe AECOPD with suspected lower respiratory tract infections. PCT levels were sequentially assessed at the time of inclusion, 6 h after and at day 1, using a sensitive immunoassay. The patients were classified according to the presence of a documented bacterial infection (including bacterial and viral coinfection) (BAC + group), or the absence of a documented bacterial infection (i.e., a documented viral infection alone or absence of a documented pathogen) (BAC- group). The accuracy of PCT levels in predicting bacterial infection (BAC + group) vs no bacterial infection (BAC- group) at different time points was evaluated by receiver operating characteristic (ROC) analysis.
Regarding the entire cohort (n = 375), at any time, the PCT levels significantly differed between groups (Kruskal-Wallis test, p < 0.001). A pairwise comparison showed that PCT levels were significantly higher in patients with bacterial infection (n = 94) than in patients without documented pathogens (n = 218) (p < 0.001). No significant difference was observed between patients with bacterial and viral infection (n = 63). For example, the median PCT-H levels were 0.64 ng/ml [0.22-0.87] in the bacterial group vs 0.24 ng/ml [0.15-0.37] in the viral group and 0.16 ng/mL [0.11-0.22] in the group without documented pathogens. With a c-index of 0.64 (95% CI; 0.58-0.71) at H, 0.64 [95% CI 0.57-0.70] at H and 0.63 (95% CI; 0.56-0.69) at H, PCT had a low accuracy for predicting bacterial infection (BAC + group).
Despite higher PCT levels in severe AECOPD caused by bacterial infection, PCT had a poor accuracy to distinguish between bacterial and nonbacterial infection. Procalcitonin might not be sufficient as a standalone marker for initiating antibiotic treatment in this setting.
为评估降钙素原（PCT）区分入住重症监护病房（ICU）的慢性阻塞性肺疾病急性加重期（AECOPD）患者细菌感染与非细菌感染病因的能力，我们对两项前瞻性研究进行了回顾性分析，这两项研究共纳入375例疑似下呼吸道感染的重症AECOPD患者。在纳入时、6小时后及第1天，使用灵敏的免疫测定法依次评估PCT水平。根据是否存在确诊的细菌感染（包括细菌和病毒合并感染）（BAC+组）或不存在确诊的细菌感染（即仅确诊病毒感染或不存在确诊病原体）（BAC-组）对患者进行分类。通过受试者工作特征（ROC）分析评估不同时间点PCT水平预测细菌感染（BAC+组）与无细菌感染（BAC-组）的准确性。
对于整个队列（n = 375），在任何时间，各组间PCT水平均有显著差异（Kruskal-Wallis检验，p < 0.001）。两两比较显示，细菌感染患者（n = 94）的PCT水平显著高于无确诊病原体患者（n = 218）（p < 0.001）。细菌和病毒合并感染患者（n = 63）之间未观察到显著差异。例如，细菌组的PCT-H中位数水平为0.64 ng/ml [0.22 - 0.87]，病毒组为0.24 ng/ml [0.15 - 0.37]，无确诊病原体组为0.16 ng/mL [0.11 - 0.22]。在H时c指数为0.64（95%CI；0.58 - 0.71），在H时为0.64 [95%CI 0.57 - 0.70]，在H时为0.63（95%CI；0.56 - 0.69），PCT预测细菌感染（BAC+组）的准确性较低。
尽管细菌感染导致的重症AECOPD患者PCT水平较高，但PCT区分细菌感染与非细菌感染的准确性较差。在这种情况下，降钙素原作为启动抗生素治疗的单一标志物可能并不充分。
