Department of clinical laboratory, Peking University People's Hospital, Beijing, PR China.
Department of clinical laboratory, Peking University People's Hospital, Beijing, PR China.
Leuk Res. 2021 Jun;105:106574. doi: 10.1016/j.leukres.2021.106574. Epub 2021 Apr 2.
Procalcitonin (PCT) and C-reactive protein (CRP) are known inflammatory markers of severe infection; however, their ability to differentiate between infections of different origins is not clear yet. In this study, we evaluated PCT and CRP as markers of infection in hematopoietic stem cell transplantation (HSCT) patients.
Blood samples were collected to determine serum concentrations of PCT, CRP, d-Dimer, and to perform blood culture analysis. Based on blood culture results, the patients were divided into two groups-positive blood culture (n = 271) patients and negative blood culture patients (n = 668); the negative blood culture group served as the control. The positive blood culture group was further divided into three groups based on the etiological agent of infection. PCT and CRP concentrations were compared, and ROC curve, sensitivity, specificity, and cutoff values were calculated.
PCT levels in infected patients were significantly higher than those in control patients (p < 0.001); similarly, CRP and d-Dimer levels were also higher among infected patients when compared with those in the controls. A PCT level of 0.51 ng/mL was the best threshold for detecting the infection, with an AUC-ROC of 0.877, whereas the best threshold for CRP was 49.20 mg/L. PCT levels were the highest in patients with gram-negative bacteremia as compared to in those with gram-positive bacteremia and fungal infection. The optimal cutoff value of PCT for the detection of gram-negative and gram-positive infection was 1.63 ng/mL.
PCT seems to be a useful marker for the diagnosis of systemic infection in HSCT patients, probably better than CRP and d-Dimer.
降钙素原（PCT）和 C 反应蛋白（CRP）是严重感染的已知炎症标志物；然而，它们区分不同来源感染的能力尚不清楚。在这项研究中，我们评估了 PCT 和 CRP 作为造血干细胞移植（HSCT）患者感染的标志物。
采集血样以确定血清 PCT、CRP、d-二聚体浓度，并进行血培养分析。根据血培养结果，将患者分为两组-阳性血培养（n=271）患者和阴性血培养患者（n=668）；阴性血培养组作为对照。阳性血培养组进一步根据感染的病原体分为三组。比较 PCT 和 CRP 浓度，并计算 ROC 曲线、敏感性、特异性和截断值。
感染患者的 PCT 水平明显高于对照组患者（p<0.001）；同样，与对照组相比，感染患者的 CRP 和 d-二聚体水平也较高。PCT 水平为 0.51ng/mL 是检测感染的最佳阈值，AUC-ROC 为 0.877，而 CRP 的最佳阈值为 49.20mg/L。与革兰氏阳性菌和真菌感染患者相比，革兰氏阴性菌血症患者的 PCT 水平最高。检测革兰氏阴性和革兰氏阳性感染的 PCT 最佳截断值为 1.63ng/mL。
PCT 似乎是 HSCT 患者全身性感染诊断的有用标志物，可能优于 CRP 和 d-二聚体。
