Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France.
Biochemistry Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France; Université de Reims Champagne-Ardenne, SFR CAP-Santé (FED 4231), Laboratoire de Biochimie Médicale et Biologie Moléculaire, 51 rue Cognacq-Jay, 51100 Reims, France; CNRS UMR 7369, Matrice Extracellulaire et Dynamique Cellulaire-MEDyC, 51 rue Cognacq-Jay, 51100 Reims, France.
Am J Emerg Med. 2021 Sep;47:109-114. doi: 10.1016/j.ajem.2021.03.050. Epub 2021 Mar 26.
Initial procalcitonin (PCT) levels may fail in mortality and septic shock prediction and raise cost-effectiveness issues. Since measurement of lactate, C-reactive protein (CRP), white blood cells and neutrophils is common in the emergency department (ED), we compared prediction abilities of these biomarkers to PCT.
From January 1st to December 31st, 2018, an observational, single center, retrospective study was conducted in the adult ED of the Reims University Hospital (France). Endpoints were bacteremia, septic shock, and in-hospital mortality, related to the same ED visit.
Over one year, 459 patients suspected with infection were included, of mean age 60.4 years (SD: 22.0), with 50.8% male, and 364 (79.3%) were hospitalized following ED visit. Overall, 45 (9.8%) patients had a bacteremia, 39 (8.5%) a septic shock and 54 (11.8%) died during their hospitalization. PCT and CRP showed the best discrimination for bacteremia, with an area under curve (AUC) of 0.68 for PCT and 0.65 for CRP. PCT and lactate showed similar good discriminative power for septic shock, with an AUC of 0.78 for both, and poor discrimination for in-hospital mortality, with an AUC of 0.62 for PCT and 0.69 for lactate. Systolic blood pressure and pulse oximetry showed similar discrimination for septic shock as PCT or lactate, while they showed higher discrimination for in-hospital mortality than PCT.
Usual admission biomarkers lack clinical utility in predicting septic shock or in-hospital mortality. CRP and PCT are poorly efficient in predicting bacteremia.
初始降钙素原 (PCT) 水平可能无法预测死亡率和脓毒性休克，且会增加成本效益问题。由于在急诊科（ED）中经常测量乳酸、C 反应蛋白 (CRP)、白细胞和中性粒细胞，我们比较了这些生物标志物与 PCT 对死亡率和脓毒性休克的预测能力。
2018 年 1 月 1 日至 12 月 31 日，在法国兰斯大学医院的成人 ED 进行了一项观察性、单中心、回顾性研究。终点是与同一 ED 就诊相关的菌血症、脓毒性休克和院内死亡率。
在一年中，共纳入 459 例疑似感染的患者，平均年龄为 60.4 岁（标准差：22.0），男性占 50.8%，364 例（79.3%）在 ED 就诊后住院。总体而言，45 例（9.8%）患者发生菌血症，39 例（8.5%）发生脓毒性休克，54 例（11.8%）在住院期间死亡。PCT 和 CRP 对菌血症的诊断具有最佳的区分能力，PCT 的 AUC 为 0.68，CRP 的 AUC 为 0.65。PCT 和乳酸对脓毒性休克的鉴别能力相似，AUC 均为 0.78，而对院内死亡率的鉴别能力较差，PCT 的 AUC 为 0.62，乳酸的 AUC 为 0.69。收缩压和脉搏血氧饱和度对脓毒性休克的鉴别能力与 PCT 或乳酸相似，而对院内死亡率的鉴别能力高于 PCT。
常规入院生物标志物在预测脓毒性休克或院内死亡率方面缺乏临床实用性。CRP 和 PCT 在预测菌血症方面效率较低。
